- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $234.42 / $389.05
| Facility | | $23.99 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $23.99
| Professional | | $15.14 | $19.05 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $9.55 / $12.02
| Professional | | $7.41 | $9.55 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $100.00
| Facility | | $8.32 | $8.32 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $12.88 / $25.12
| Professional | | $6.76 | $12.88 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $15.14
| Professional | | $12.02 | $12.02 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $4.90
| Facility | | $3.31 | $3.31 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.61 / $10.96
| Professional | | $3.31 | $6.61 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $15.85
| Professional | | $12.02 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.88 / $12.88
| Professional | | $11.48 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $13.80 / $112.20
| Facility | | $5.62 | $13.80 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $9.12 / $44.67
| Professional | | $4.90 | $9.12 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.47 / $6.31
| Facility | | $3.31 | $3.47 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.31 / $10.96
| Professional | | $3.31 | $6.31 | $10.96 |