- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $12.88 / $19.95
| Professional | | $6.61 | $12.88 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $42.66
| Professional | | $17.78 | $17.78 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $15.14 / $19.95
| Facility | | $2.00 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $15.14 / $19.95
| Professional | | $2.00 | $15.14 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $19.05
| Facility | | $14.45 | $14.45 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.45 / $19.05
| Professional | | $12.30 | $14.45 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.13 / $21.88
| Professional | | $12.59 | $14.13 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $17.38 / $18.20
| Professional | | $14.13 | $17.38 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $7.76 / $14.45
| Facility | | $1.00 | $7.76 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $13.49 / $23.99
| Professional | | $7.94 | $13.49 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $14.13 / $17.38
| Facility | | $13.80 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.14 / $17.38
| Professional | | $14.13 | $15.14 | $17.38 |