- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $93.33 / $239.88
| Facility | | $27.54 | $93.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $45.71 / $93.33
| Professional | | $19.95 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $39.81
| Professional | | $15.14 | $15.14 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $46.77
| Facility | | $23.44 | $26.92 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $33.11
| Professional | | $12.59 | $15.85 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $31.62
| Facility | | $16.98 | $26.92 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $25.70 / $34.67
| Professional | | $16.60 | $25.70 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $33.11 / $104.71
| Facility | | $16.60 | $33.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $48.98
| Professional | | $12.88 | $16.60 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $45.71 / $97.72
| Facility | | $10.96 | $45.71 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $18.20 / $38.90
| Professional | | $10.23 | $18.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $31.62
| Professional | | $19.05 | $22.91 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $52.48
| Professional | | $17.78 | $26.92 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $38.02
| Facility | | $12.59 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $31.62
| Professional | | $10.72 | $15.14 | $31.62 |