- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $125.89
| Facility | | $19.95 | $50.12 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.95 / $1,288.25
| Professional | | $19.05 | $19.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $21.88 / $24.55
| Facility | | $0.02 | $21.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $41.69
| Professional | | $20.42 | $20.42 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $41.69
| Facility | | $20.42 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $63.10
| Professional | | $19.95 | $25.70 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $67.61 / $398.11
| Professional | | $37.15 | $67.61 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $28.84
| Facility | | $21.38 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $79.43
| Professional | | $50.12 | $50.12 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $48.98
| Professional | | $19.50 | $19.50 | $48.98 |