- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $57.54 / $97.72
| Facility | | $19.95 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $64.57
| Professional | | $15.85 | $19.05 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $69.18
| Facility | | $18.20 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $173.78
| Professional | | $12.02 | $20.89 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $79.43
| Facility | | $39.81 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.50
| Professional | | $19.05 | $19.05 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $77.62
| Facility | | $16.22 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $24.55 / $53.70
| Professional | | $12.02 | $24.55 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $154.88 / $8,511.38
| Facility | | $28.18 | $154.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $33.88
| Professional | | $28.84 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $38.90
| Professional | | $19.95 | $19.95 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $61.66 / $125.89
| Facility | | $23.44 | $61.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $69.18
| Facility | | $18.20 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $173.78
| Professional | | $12.02 | $20.89 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $33.88
| Facility | | $17.78 | $22.39 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.95 / $33.11
| Facility | | $16.98 | $19.95 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $45.71
| Professional | | $12.02 | $19.95 | $45.71 |