- 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
- $10.96 / $15.14 / $21.88
| Professional | | $10.96 | $15.14 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $12.30
| Professional | | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $56.23 / $69.18
| Professional | | $25.70 | $56.23 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $34.67
| Facility | | $20.42 | $25.70 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $26.92 / $38.02
| Professional | | $24.55 | $26.92 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $33.88
| Facility | | $26.92 | $33.11 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $33.88
| Professional | | $25.12 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $26.30 / $38.02
| Facility | | $16.22 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $32.36 / $70.79
| Professional | | $12.30 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $53.70 / $131.83
| Facility | | $28.18 | $53.70 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.02 / $38.02
| Professional | | $33.88 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $40.74
| Facility | | $12.88 | $19.05 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $23.99
| Professional | | $11.48 | $12.59 | $23.99 |