- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $57.54 / $75.86
| Facility | | $23.99 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $39.81
| Professional | | $12.88 | $23.99 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $5,011.87
| Facility | | $22.39 | $26.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $66.07 / $70.79
| Facility | | $18.62 | $66.07 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Professional | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Facility | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $32.36
| Professional | | $28.18 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $24.55 / $74.13
| Facility | | $0.71 | $24.55 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $23.99 / $64.57
| Facility | | $6.76 | $23.99 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $26.30
| Professional | | $19.05 | $23.99 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.46 / $28.18
| Facility | | $4.17 | $6.46 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.90 / $28.18
| Professional | | $3.55 | $4.90 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Facility | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $24.55 / $33.88
| Professional | | $23.44 | $24.55 | $33.88 |