- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $77.62 / $141.25
| Facility | | $19.95 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $11.75 / $29.51
| Professional | | $10.96 | $11.75 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $45.71
| Facility | | $20.89 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.45 / $24.55
| Professional | | $8.71 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.18 / $33.11
| Professional | | $26.92 | $28.18 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $13.80 / $112.20
| Facility | | $12.88 | $13.80 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $21.88
| Professional | | $10.47 | $14.13 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $26.30
| Facility | | $12.88 | $12.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $15.49
| Professional | | $12.88 | $12.88 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $38.90
| Facility | | $11.48 | $17.78 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.13 / $79.43
| Professional | | $10.23 | $14.13 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $53.70
| Facility | | $19.50 | $38.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.55 / $15.49
| Professional | | $7.76 | $9.55 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $15.49 / $20.42
| Facility | | $8.13 | $15.49 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $17.78
| Professional | | $7.76 | $10.47 | $17.78 |