- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $1,412.54
| Facility | | $30.20 | $52.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $32.36
| Professional | | $19.95 | $25.70 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $208.93
| Facility | | $134.90 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $24.55
| Professional | | $14.79 | $14.79 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $26.92 / $57.54
| Professional | | $23.99 | $26.92 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $56.23 / $144.54
| Facility | | $1.58 | $56.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $43.65
| Professional | | $11.48 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $51.29
| Professional | | $24.55 | $30.90 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $48.98
| Facility | | $16.98 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $19.95
| Professional | | $13.18 | $13.18 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $69.18
| Facility | | $19.05 | $27.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $69.18
| Professional | | $19.95 | $28.84 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $33.11 / $48.98
| Facility | | $12.88 | $33.11 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $16.22 / $24.55
| Professional | | $10.23 | $16.22 | $24.55 |