- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $51.29 / $83.18
| Facility | | $18.20 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $38.90
| Professional | | $14.13 | $18.20 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $239.88
| Facility | | $17.78 | $27.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $19.50 / $47.86
| Professional | | $11.75 | $19.50 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $75.86
| Facility | | $38.02 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $25.12
| Professional | | $18.20 | $18.20 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $30.90 / $75.86
| Facility | | $15.14 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $22.39 / $51.29
| Professional | | $12.02 | $22.39 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $154.88 / $7,079.46
| Facility | | $22.39 | $154.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $33.11
| Professional | | $28.18 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $53.70
| Professional | | $19.50 | $19.50 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $239.88
| Facility | | $17.78 | $27.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $19.50 / $47.86
| Professional | | $11.75 | $19.50 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $19.50 / $28.84
| Facility | | $9.77 | $19.50 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.22 / $52.48
| Professional | | $11.75 | $16.22 | $52.48 |