- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $56.23 / $165.96
| Facility | | $23.99 | $56.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $37.15
| Professional | | $23.99 | $25.12 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $40.74
| Professional | | $24.55 | $24.55 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $25.12 / $32.36
| Professional | | $24.55 | $25.12 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $61.66
| Facility | | $25.70 | $46.77 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $42.66
| Professional | | $20.89 | $24.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $213.80
| Professional | | $35.48 | $35.48 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $67.61
| Facility | | $25.12 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $37.15 / $117.49
| Professional | | $35.48 | $37.15 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $41.69
| Facility | | $23.44 | $32.36 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $41.69
| Professional | | $23.44 | $32.36 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $52.48
| Facility | | $40.74 | $40.74 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.30 / $29.51
| Professional | | $25.12 | $26.30 | $29.51 |