- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $194.98
| Facility | | $23.99 | $25.12 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $32.36
| Professional | | $17.78 | $21.88 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | CO | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $63.10
| Facility | | $33.88 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $31.62 / $31.62
| Professional | | $30.20 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $47.86
| Facility | | $15.14 | $26.92 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $64.57
| Facility | | $53.70 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $46.77 / $75.86
| Professional | | $22.39 | $46.77 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $85.11
| Facility | | $23.99 | $25.70 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $50.12
| Professional | | $20.89 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | CO | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $75.86 / $75.86
| Professional | | $26.30 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $30.90
| Facility | | $25.12 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $41.69
| Professional | | $25.12 | $28.84 | $41.69 |