- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $95.50 / $208.93
| Facility | | $41.69 | $95.50 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $32.36
| Professional | | $16.98 | $21.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.49 / $758.58
| Facility | | $14.13 | $15.49 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $89.13
| Professional | | $13.49 | $19.95 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $107.15 / $251.19
| Facility | | $46.77 | $107.15 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $38.90
| Professional | | $19.05 | $25.70 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $3.02 / $95.50
| Facility | | $0.83 | $3.02 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $19.95 / $57.54
| Professional | | $10.72 | $19.95 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $23.99 / $100.00
| Professional | | $19.95 | $23.99 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $81.28 / $398.11
| Professional | | $26.92 | $81.28 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $19.95 / $28.84
| Professional | | $14.45 | $19.95 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $3.63 / $63.10
| Facility | | $1.20 | $3.63 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $17.38 / $57.54
| Professional | | $10.72 | $17.38 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $56.23
| Professional | | $19.95 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $15.49 / $426.58
| Facility | | $9.12 | $15.49 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $13.80 / $70.79
| Professional | | $7.94 | $13.80 | $70.79 |