- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $35.48 / $123.03
| Facility | | $19.50 | $35.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $32.36
| Professional | | $15.85 | $19.95 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Professional | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $43.65
| Facility | | $21.88 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.95 / $21.88
| Professional | | $16.60 | $19.95 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $70.79
| Facility | | $22.91 | $46.77 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $23.44 / $34.67
| Professional | | $13.49 | $23.44 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.50 / $64.57
| Professional | | $14.13 | $19.50 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $44.67
| Facility | | $21.88 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $44.67
| Professional | | $21.88 | $21.88 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $60.26
| Facility | | $21.88 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.30
| Professional | | $19.95 | $19.95 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $57.54
| Facility | | $21.88 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.95 / $21.88
| Professional | | $16.60 | $19.95 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $26.30
| Facility | | $19.95 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.59 / $26.30
| Professional | | $9.12 | $12.59 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $11.48 / $39.81
| Professional | | $9.77 | $11.48 | $39.81 |