- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $25.70 / $346.74
| Facility | | $10.00 | $25.70 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $18.20 / $37.15
| Professional | | $9.33 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.60 / $20.89
| Professional | | $10.47 | $16.60 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $151.36 / $288.40
| Facility | | $57.54 | $151.36 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.38 / $44.67
| Professional | | $10.96 | $21.38 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $16.22 / $25.70
| Facility | | $9.33 | $16.22 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $19.05 / $33.11
| Professional | | $10.47 | $19.05 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $27.54 / $74.13
| Professional | | $12.30 | $27.54 | $74.13 |
- 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
- $10.72 / $11.48 / $23.99
| Professional | | $10.72 | $11.48 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $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
- $10.23 / $19.05 / $33.88
| Professional | | $10.23 | $19.05 | $33.88 |