- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $63.10 / $109.65
| Facility | | $19.95 | $63.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $41.69
| Professional | | $15.85 | $19.95 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $5,011.87
| Facility | | $107.15 | $144.54 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.95
| Professional | | $19.05 | $19.05 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $83.18
| Facility | | $17.78 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $31.62 / $60.26
| Professional | | $14.45 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $35.48
| Professional | | $11.48 | $14.45 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $42.66
| Professional | | $20.89 | $24.55 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $74.13
| Facility | | $51.29 | $64.57 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $53.70 / $87.10
| Facility | | $19.95 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $30.90
| Professional | | $15.85 | $19.95 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $25.12
| Facility | | $19.95 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $25.12
| Professional | | $15.14 | $24.55 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $24.55 / $29.51
| Facility | | $14.45 | $24.55 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $37.15
| Professional | | $10.47 | $15.14 | $37.15 |