- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $75.86 / $288.40
| Facility | | $10.00 | $75.86 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.23 / $14.45
| Professional | | $8.51 | $10.23 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.13 / $8.13
| Professional | | $6.92 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $51.29
| Facility | | $20.89 | $25.70 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $14.45
| Professional | | $6.92 | $10.47 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $23.99 / $52.48
| Facility | | $7.94 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.13 / $17.38
| Professional | | $6.03 | $8.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $22.39 / $114.82
| Professional | | $9.55 | $22.39 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.47 / $22.91
| Facility | | $9.33 | $10.47 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $28.18 / $30.90
| Professional | | $9.33 | $28.18 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $691.83
| Facility | | $338.84 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $13.80 / $20.42
| Facility | | $6.03 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.13 / $16.22
| Professional | | $5.75 | $8.13 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |