- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $20.42 / $288.40
| Facility | | $10.00 | $20.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $15.14
| Professional | | $7.94 | $10.00 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $48.98
| Facility | | $28.84 | $40.74 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $9.33 / $13.80
| Professional | | $7.94 | $9.33 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $27.54 / $60.26
| Facility | | $9.12 | $27.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.12 / $19.95
| Professional | | $6.92 | $9.12 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $54.95
| Professional | | $10.96 | $10.96 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $14.13 / $25.70
| Facility | | $7.94 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $6.03
| Professional | | $5.50 | $5.50 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $13.18 / $22.91
| Facility | | $6.61 | $13.18 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $9.12 / $18.62
| Professional | | $5.50 | $9.12 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $114.82
| Facility | | $102.33 | $102.33 | $114.82 |