- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $77.62 / $199.53
| Facility | | $19.95 | $77.62 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.50 / $26.30
| Professional | | $15.85 | $19.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $12.88
| Professional | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $42.66
| Facility | | $22.39 | $31.62 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $21.38
| Professional | | $16.22 | $19.05 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $45.71 / $69.18
| Facility | | $22.39 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $22.39 / $33.88
| Professional | | $13.18 | $22.39 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $64.57
| Professional | | $13.80 | $19.05 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $42.66
| Facility | | $21.38 | $21.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $23.44
| Professional | | $21.38 | $21.38 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $58.88
| Facility | | $21.38 | $37.15 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $25.70
| Professional | | $19.05 | $19.05 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $56.23
| Facility | | $24.55 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $21.38
| Professional | | $16.22 | $19.05 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $25.70
| Facility | | $19.05 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $26.92
| Professional | | $8.91 | $12.59 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $10.96 / $38.90
| Professional | | $9.55 | $10.96 | $38.90 |