- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $194.98
| Facility | | $19.50 | $28.84 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $22.39
| Professional | | $10.00 | $12.88 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $51.29
| Facility | | $25.12 | $40.74 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $17.38 / $27.54
| Professional | | $9.77 | $17.38 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $39.81
| Professional | | $31.62 | $33.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $23.99
| Facility | | $15.49 | $15.49 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $25.12
| Professional | | $15.49 | $19.50 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $30.90
| Facility | | $15.49 | $15.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $16.98
| Professional | | $15.49 | $15.49 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.38 / $45.71
| Facility | | $13.80 | $21.38 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $79.43
| Professional | | $14.13 | $18.62 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $46.77 / $64.57
| Facility | | $23.44 | $46.77 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $18.62
| Professional | | $11.48 | $14.45 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $18.62 / $24.55
| Facility | | $8.91 | $18.62 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.13 / $19.95
| Professional | | $6.46 | $8.13 | $19.95 |