- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $138.04
| Facility | | $19.95 | $50.12 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $33.88
| Professional | | $15.14 | $19.95 | $33.88 |
- 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
- $33.11 / $85.11 / $141.25
| Facility | | $33.11 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $14.79 / $36.31
| Professional | | $5.01 | $14.79 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $123.03
| Facility | | $25.12 | $38.90 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $79.43
| Facility | | $26.92 | $26.92 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $53.70 / $120.23
| Facility | | $23.99 | $53.70 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $44.67
| Professional | | $12.88 | $16.98 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $91.20
| Facility | | $19.95 | $32.36 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $23.99 / $41.69
| Professional | | $14.13 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $26.92
| Professional | | $22.39 | $22.39 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $57.54
| Professional | | $26.30 | $28.84 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $79.43
| Facility | | $20.42 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $45.71
| Professional | | $12.88 | $21.38 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $32.36
| Facility | | $11.22 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.75 / $28.18
| Professional | | $11.22 | $11.75 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $18.62 / $26.92
| Professional | | $10.47 | $18.62 | $26.92 |