- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $97.72
| Facility | | $20.89 | $38.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.85 / $38.90
| Professional | | $10.00 | $15.85 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $52.48
| Facility | | $27.54 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $18.62 / $30.20
| Professional | | $10.00 | $18.62 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $42.66
| Professional | | $33.88 | $37.15 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $41.69
| Facility | | $16.98 | $16.98 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $20.42 / $26.92
| Professional | | $16.98 | $20.42 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $33.88
| Facility | | $16.98 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $20.42
| Professional | | $16.98 | $16.98 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.44 / $50.12
| Facility | | $15.14 | $23.44 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $79.43
| Professional | | $15.14 | $19.05 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $69.18
| Facility | | $25.12 | $50.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.49 / $20.42
| Professional | | $12.59 | $15.49 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.42 / $26.92
| Facility | | $9.12 | $20.42 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $20.42
| Professional | | $7.08 | $8.32 | $20.42 |