- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $61.66 / $144.54
| Facility | | $19.95 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $30.20
| Professional | | $15.14 | $18.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $14.13
| Professional | | $12.30 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $40.74
| Facility | | $21.38 | $30.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $20.42
| Professional | | $15.14 | $18.20 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $42.66 / $64.57
| Facility | | $20.89 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.38 / $32.36
| Professional | | $12.59 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $64.57
| Professional | | $12.88 | $17.78 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $40.74
| Facility | | $20.42 | $20.42 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $56.23
| Facility | | $20.42 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $24.55
| Professional | | $18.20 | $18.20 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.20 / $53.70
| Facility | | $23.44 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $20.42
| Professional | | $15.14 | $18.20 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $24.55
| Facility | | $18.20 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $12.02 / $25.70
| Professional | | $8.51 | $12.02 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $36.31
| Professional | | $9.12 | $10.47 | $36.31 |