- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $54.95
| Professional | | $23.99 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $33.11
| Professional | 26 | $19.05 | $23.99 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | 52 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $26.92
| Professional | TC | $2.00 | $3.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $33.11
| Professional | | $26.92 | $28.84 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.01 / $44.67
| Professional | | $3.47 | $5.01 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $74.13
| Professional | | $22.39 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $25.70 / $44.67
| Professional | 26 | $17.38 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.88 / $5.13 / $43.65
| Professional | TC | $2.88 | $5.13 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $28.18 / $41.69
| Professional | | $13.49 | $28.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $22.39 / $28.18
| Professional | 26 | $6.76 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.24 / $4.37 / $26.92
| Professional | TC | $3.24 | $4.37 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $32.36 / $33.11
| Professional | | $7.76 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $58.88
| Professional | | $19.95 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $20.42 / $34.67
| Professional | 26 | $12.88 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.75 / $4.57 / $38.90
| Professional | TC | $2.75 | $4.57 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $28.84
| Professional | | $21.88 | $21.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $24.55
| Professional | 26 | $19.05 | $19.05 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $4.37
| Professional | TC | $3.09 | $3.09 | $4.37 |