- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $61.66 / $371.54
| Facility | | $17.78 | $61.66 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.30 / $21.38
| Professional | | $10.00 | $12.30 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $50.12
| Facility | | $22.39 | $36.31 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $15.49 / $26.30
| Professional | | $9.33 | $15.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $34.67
| Professional | | $28.18 | $30.90 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $128.82
| Facility | | $13.80 | $13.80 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $26.30
| Professional | | $13.80 | $17.38 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $28.18
| Facility | | $13.80 | $13.80 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $28.18
| Professional | | $13.80 | $13.80 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $41.69
| Facility | | $13.49 | $19.95 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $79.43
| Professional | | $13.80 | $16.60 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $57.54
| Facility | | $20.89 | $41.69 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $17.78
| Professional | | $10.47 | $14.13 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.60 / $22.39
| Facility | | $8.71 | $16.60 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.94 / $19.50
| Professional | | $5.75 | $7.94 | $19.50 |