- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.95 / $109.65
| Facility | | $10.00 | $19.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $15.14
| Professional | | $7.94 | $10.00 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $56.23
| Facility | | $28.18 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.48 / $14.79
| Professional | | $7.76 | $11.48 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $26.92 / $58.88
| Facility | | $8.91 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.91 / $19.50
| Professional | | $6.76 | $8.91 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $28.18 / $38.90
| Professional | | $10.72 | $28.18 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $25.12
| Facility | | $10.23 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $6.03
| Professional | | $5.50 | $5.50 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $12.88 / $22.39
| Facility | | $6.46 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.91 / $17.78
| Professional | | $5.37 | $8.91 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $72.44
| Facility | | $70.79 | $70.79 | $72.44 |