- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $57.54 / $93.33
| Facility | | $19.95 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $43.65
| Professional | | $15.85 | $19.95 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $199.53
| Facility | | $19.95 | $30.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $21.88 / $53.70
| Professional | | $13.18 | $21.88 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $77.62
| Facility | | $42.66 | $53.70 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $28.18
| Professional | | $20.89 | $20.89 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $85.11
| Facility | | $16.98 | $34.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.12 / $57.54
| Professional | | $13.49 | $25.12 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $173.78 / $7,079.46
| Facility | | $25.12 | $173.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $37.15
| Professional | | $31.62 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $60.26
| Professional | | $21.88 | $21.88 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $199.53
| Facility | | $19.95 | $30.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $21.88 / $53.70
| Professional | | $13.18 | $21.88 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.88 / $36.31
| Facility | | $12.59 | $21.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $19.05 / $60.26
| Professional | | $13.18 | $19.05 | $60.26 |