- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $46.77 / $213.80
| Facility | | $22.39 | $46.77 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $46.77
| Professional | | $15.85 | $19.95 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.49 / $34.67
| Professional | | $11.22 | $13.49 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.44 / $40.74
| Facility | | $20.42 | $23.44 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $28.84
| Professional | | $10.96 | $13.80 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Facility | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.44 / $27.54
| Facility | | $15.14 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.39 / $30.20
| Professional | | $14.45 | $22.39 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $28.84 / $91.20
| Facility | | $14.79 | $28.84 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $42.66
| Professional | | $11.22 | $14.79 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $54.95 / $218.78
| Facility | | $14.45 | $54.95 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $17.78 / $66.07
| Professional | | $8.91 | $17.78 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.95 / $27.54
| Professional | | $16.60 | $19.95 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $24.55 / $48.98
| Professional | | $15.49 | $24.55 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $33.11
| Facility | | $11.22 | $22.39 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $13.49 / $29.51
| Professional | | $9.33 | $13.49 | $29.51 |