- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $63.10 / $134.90
| Facility | | $19.95 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $46.77
| Professional | | $12.02 | $14.79 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $10.00 / $16.60
| Professional | | $9.77 | $10.00 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $72.44 / $269.15
| Facility | | $25.12 | $72.44 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $5,011.87
| Facility | | $87.10 | $114.82 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $15.85
| Professional | | $12.88 | $12.88 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $25.12 / $56.23
| Facility | | $11.75 | $25.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $21.38 / $39.81
| Professional | | $9.77 | $21.38 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $23.99
| Professional | | $7.76 | $12.59 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $28.84
| Professional | | $16.22 | $18.20 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $97.72
| Facility | | $22.91 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $15.85
| Professional | | $9.77 | $9.77 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $70.79 / $269.15
| Facility | | $19.05 | $70.79 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $33.88 / $74.13
| Facility | | $11.48 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $28.18
| Professional | | $12.02 | $14.13 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $275.42 / $416.87
| Facility | | $269.15 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $17.78 / $18.20
| Facility | | $10.47 | $17.78 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $18.20
| Professional | | $10.47 | $16.98 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $16.60 / $19.95
| Facility | | $9.55 | $16.60 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.96 / $28.84
| Professional | | $6.92 | $10.96 | $28.84 |