- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $97.72 / $117.49
| Facility | | $23.99 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $91.20
| Professional | | $23.44 | $40.74 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $67.61
| Professional | | $17.38 | $30.20 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $69.18
| Facility | | $26.92 | $46.77 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $50.12
| Professional | | $17.38 | $26.92 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $75.86
| Facility | | $41.69 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $47.86
| Professional | | $41.69 | $45.71 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $66.07 / $107.15
| Facility | | $34.67 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $42.66 / $91.20
| Professional | | $17.78 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $70.79
| Professional | | $31.62 | $45.71 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $831.76
| Facility | | $512.86 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.02 / $74.13
| Professional | | $33.88 | $38.02 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $31.62 / $43.65
| Facility | | $29.51 | $31.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $20.89 / $61.66
| Professional | | $14.79 | $20.89 | $61.66 |