- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $58.88 / $93.33
| Facility | | $19.95 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $38.90
| Professional | | $15.14 | $18.20 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $5,011.87
| Facility | | $114.82 | $151.36 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $21.38
| Professional | | $16.60 | $16.60 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $33.11 / $74.13
| Facility | | $15.49 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $52.48
| Professional | | $12.59 | $27.54 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $21.38 / $30.90
| Professional | | $10.00 | $21.38 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $37.15
| Professional | | $20.89 | $23.99 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $56.23 / $74.13
| Facility | | $17.38 | $56.23 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $26.92
| Professional | | $15.14 | $18.20 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $31.62
| Facility | | $21.38 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $37.15
| Professional | | $17.78 | $28.84 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.38 / $25.70
| Facility | | $12.59 | $21.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $37.15
| Professional | | $9.12 | $14.13 | $37.15 |