- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $51.29 / $218.78
| Facility | | $22.91 | $51.29 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $16.98 / $33.11
| Professional | | $15.85 | $16.98 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $47.86
| Facility | | $23.99 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $23.99
| Professional | | $18.20 | $21.88 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $51.29 / $64.57
| Facility | | $23.44 | $51.29 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $25.70 / $35.48
| Professional | | $12.30 | $25.70 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.38 / $64.57
| Professional | | $15.49 | $21.38 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $47.86
| Facility | | $23.99 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $28.84
| Professional | | $23.99 | $23.99 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $72.44
| Facility | | $23.99 | $38.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $28.84
| Professional | | $21.88 | $21.88 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $64.57
| Facility | | $27.54 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $23.99
| Professional | | $18.20 | $21.88 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $28.84
| Facility | | $21.88 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.72 / $26.92
| Professional | | $10.23 | $10.72 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.59 / $43.65
| Professional | | $10.96 | $12.59 | $43.65 |