- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $97.72 / $309.03
| Facility | | $19.95 | $97.72 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $72.44
| Professional | | $7.94 | $12.02 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $38.02
| Facility | | $18.62 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $12.88 / $20.42
| Professional | | $7.24 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $30.20
| Professional | | $23.99 | $25.70 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $54.95 / $223.87
| Facility | | $11.48 | $54.95 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $19.05
| Professional | | $11.48 | $14.45 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $23.44
| Facility | | $11.48 | $11.48 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $23.44
| Professional | | $11.48 | $12.59 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.60 / $33.88
| Facility | | $10.47 | $16.60 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.80 / $79.43
| Professional | | $10.72 | $13.80 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $47.86
| Facility | | $17.38 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.96 / $13.80
| Professional | | $8.71 | $10.96 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $13.80 / $18.62
| Facility | | $6.76 | $13.80 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.17 / $15.14
| Professional | | $4.90 | $6.17 | $15.14 |