- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $70.79 / $186.21
| Facility | | $27.54 | $70.79 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $42.66
| Professional | | $19.95 | $28.84 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $112.20 / $204.17
| Facility | | $46.77 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $47.86 / $52.48
| Professional | | $5.50 | $47.86 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $38.90 / $38.90
| Facility | | $22.39 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $72.44 / $173.78
| Facility | | $23.99 | $72.44 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $19.95 / $56.23
| Professional | | $12.59 | $19.95 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $72.44
| Facility | | $27.54 | $38.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $57.54
| Professional | | $19.50 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $33.11
| Professional | | $29.51 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.90 / $100.00
| Facility | | $24.55 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $43.65
| Professional | | $12.59 | $15.14 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $38.90 / $46.77
| Facility | | $13.80 | $38.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.22 / $27.54
| Professional | | $11.22 | $16.22 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $38.90
| Professional | | $15.14 | $20.42 | $38.90 |