- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $173.78 / $173.78
| Facility | | $37.15 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $39.81
| Professional | | $19.95 | $26.92 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $2.69 / $64.57
| Facility | | $1.66 | $2.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $37.15 / $51.29
| Professional | | $18.62 | $37.15 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $70.79
| Professional | | $45.71 | $53.70 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $58.88
| Facility | | $20.89 | $35.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $61.66
| Professional | | $19.95 | $30.20 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $67.61
| Facility | | $41.69 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $50.12
| Professional | | $41.69 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $60.26
| Facility | | $19.95 | $33.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $79.43
| Professional | | $25.12 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $229.09
| Facility | | $91.20 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $93.33
| Professional | | $51.29 | $72.44 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $288.40
| Facility | | $177.83 | $218.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $15.14 / $36.31
| Professional | | $10.23 | $15.14 | $36.31 |