- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $50.12
| Facility | | $23.99 | $23.99 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $87.10
| Professional | | $15.85 | $23.99 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $213.80
| Facility | | $38.02 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $107.15
| Professional | | $30.20 | $40.74 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $190.55 / $251.19
| Facility | | $165.96 | $190.55 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $70.79
| Professional | | $40.74 | $40.74 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $81.28 / $91.20
| Facility | | $19.95 | $81.28 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $97.72
| Professional | | $22.39 | $37.15 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $35.48 / $83.18
| Facility | | $16.22 | $35.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $54.95
| Professional | | $16.22 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $89.13
| Professional | | $34.67 | $40.74 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $131.83
| Facility | | $81.28 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $213.80 / $426.58
| Professional | | $75.86 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $213.80
| Facility | | $38.02 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $107.15
| Professional | | $30.20 | $40.74 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $33.88
| Facility | | $23.99 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $93.33
| Professional | | $30.20 | $39.81 | $93.33 |