- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $100.00 / $363.08
| Facility | | $37.15 | $100.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $15.14 / $48.98
| Professional | | $12.30 | $15.14 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.23 / $16.98
| Professional | | $8.32 | $10.23 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $19.95
| Facility | | $14.79 | $16.98 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.98 / $23.44
| Professional | | $13.80 | $16.98 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $18.62 / $43.65
| Facility | | $11.75 | $18.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $17.38 / $26.92
| Professional | | $8.91 | $17.38 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $72.44 / $158.49
| Facility | | $16.60 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $23.44 / $33.11
| Professional | | $8.51 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $8.13 / $10.47
| Professional | | $2.04 | $8.13 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $20.89
| Facility | | $7.08 | $12.88 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $23.44
| Professional | | $7.08 | $9.77 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |