- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $35.48 / $89.13
| Facility | | $12.88 | $35.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $87.10
| Professional | | $12.02 | $19.05 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $33.88
| Professional | | $14.79 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $70.79 / $269.15
| Professional | | $19.95 | $70.79 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $870.96
| Facility | | $524.81 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $28.84 / $125.89
| Professional | | $15.49 | $28.84 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $27.54
| Professional | | $19.05 | $25.12 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $102.33 / $120.23
| Professional | | $97.72 | $102.33 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $147.91
| Facility | | $16.60 | $26.92 | $147.91 |
- 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
- $10.00 / $15.85 / $4,073.80
| Facility | | $10.00 | $15.85 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.49 / $4,073.80
| Professional | | $10.00 | $15.49 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $32.36 / $95.50
| Facility | | $11.75 | $32.36 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $104.71
| Professional | | $15.14 | $26.92 | $104.71 |