- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $25.70
| Professional | | $14.13 | $18.20 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $69.18 / $85.11
| Professional | | $26.92 | $69.18 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $35.48
| Facility | | $20.42 | $26.92 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $27.54 / $38.90
| Professional | | $25.12 | $27.54 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $34.67
| Facility | | $27.54 | $33.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $35.48 / $38.02
| Professional | | $34.67 | $35.48 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $40.74
| Facility | | $19.95 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $70.79
| Professional | | $17.78 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $134.90
| Facility | | $28.84 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $38.90
| Professional | | $34.67 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $51.29
| Facility | | $12.02 | $19.95 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.85 / $30.20
| Professional | | $13.80 | $15.85 | $30.20 |