- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $151.36 / $398.11
| Facility | | $44.67 | $151.36 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $177.83
| Professional | | $19.95 | $31.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.60 / $43.65
| Professional | | $12.30 | $16.60 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $63.10 / $134.90
| Facility | | $15.49 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $53.70
| Professional | | $13.18 | $19.50 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $316.23
| Facility | | $54.95 | $117.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $87.10
| Professional | | $21.38 | $30.20 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $47.86 / $100.00
| Facility | | $20.89 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $31.62 / $72.44
| Professional | | $15.85 | $31.62 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $43.65
| Professional | | $22.39 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $61.66
| Professional | | $21.88 | $26.92 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $32.36
| Professional | | $16.22 | $16.22 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $75.86
| Facility | | $19.95 | $31.62 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $72.44
| Professional | | $15.85 | $24.55 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $38.02
| Professional | | $21.88 | $25.12 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $26.92
| Facility | | $12.30 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $15.85 / $60.26
| Professional | | $11.48 | $15.85 | $60.26 |