- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $44.67
| Professional | | $23.99 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $32.36
| Professional | 26 | $19.05 | $23.99 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | 52 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $8.91
| Professional | TC | $3.02 | $3.98 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $39.81
| Professional | | $30.20 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $33.88
| Professional | 26 | $26.30 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.24 / $4.57 / $5.62
| Professional | TC | $3.24 | $4.57 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Professional | 26 | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $69.18
| Professional | | $23.44 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $41.69
| Professional | 26 | $19.50 | $26.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.63 / $4.37 / $16.22
| Professional | TC | $2.63 | $4.37 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $53.70
| Professional | | $21.38 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $21.38 / $32.36
| Professional | 26 | $15.49 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.57 / $3.80 / $30.20
| Professional | TC | $2.57 | $3.80 | $30.20 |