- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $66.07 / $194.98
| Facility | | $23.99 | $66.07 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $43.65
| Professional | | $15.85 | $19.05 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $5,011.87
| Facility | | $120.23 | $162.18 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $21.38
| Professional | | $17.78 | $17.78 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $34.67 / $77.62
| Facility | | $16.60 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $29.51 / $54.95
| Professional | | $13.49 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $22.91 / $33.11
| Professional | | $10.72 | $22.91 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $25.70 / $39.81
| Professional | | $22.39 | $25.70 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $208.93
| Facility | | $42.66 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $16.98
| Professional | | $13.80 | $15.49 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $69.18
| Facility | | $18.62 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $26.92
| Professional | | $15.14 | $18.20 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $30.90
| Facility | | $22.91 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $30.90
| Professional | | $19.95 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $22.91 / $27.54
| Facility | | $13.49 | $22.91 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $16.98 / $39.81
| Professional | | $10.23 | $16.98 | $39.81 |