- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $67.61 / $338.84
| Facility | | $13.80 | $67.61 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $56.23
| Professional | | $6.03 | $10.00 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.37 / $7.76
| Professional | | $2.88 | $4.37 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $20.42 / $43.65
| Facility | | $7.41 | $20.42 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $7.59 / $25.70
| Professional | | $4.27 | $7.59 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $63.10 / $138.04
| Facility | | $19.95 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.77 / $21.38
| Professional | | $6.92 | $9.77 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $15.14 / $31.62
| Facility | | $6.61 | $15.14 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.00 / $19.95
| Professional | | $5.50 | $10.00 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.71 / $13.80
| Professional | | $7.59 | $8.71 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.71 / $19.95
| Professional | | $6.92 | $8.71 | $19.95 |
- 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
- $7.41 / $8.32 / $15.49
| Professional | | $7.41 | $8.32 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $10.47
| Professional | | $5.25 | $5.25 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $25.70
| Facility | | $6.92 | $10.47 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $8.71 / $19.95
| Professional | | $5.25 | $8.71 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.91 / $14.79
| Professional | | $6.92 | $8.91 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $6.03 / $8.71
| Facility | | $3.89 | $6.03 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $5.25 / $18.20
| Professional | | $3.63 | $5.25 | $18.20 |