- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $44.67 / $85.11
| Facility | | $19.05 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $50.12
| Professional | | $15.14 | $19.05 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $95.50
| Facility | | $18.20 | $28.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $173.78
| Professional | | $12.02 | $19.95 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $79.43
| Facility | | $39.81 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $25.70
| Professional | | $19.05 | $19.05 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $31.62 / $77.62
| Facility | | $15.49 | $31.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $23.99 / $48.98
| Professional | | $12.02 | $23.99 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $158.49 / $7,079.46
| Facility | | $22.91 | $158.49 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $33.88
| Professional | | $28.84 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $36.31
| Professional | | $19.95 | $19.95 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $95.50
| Facility | | $18.20 | $28.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $173.78
| Professional | | $12.02 | $19.95 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.95 / $29.51
| Facility | | $10.00 | $19.95 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.95 / $38.90
| Professional | | $10.00 | $19.95 | $38.90 |