- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $89.13 / $194.98
| Facility | | $18.20 | $89.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $19.50
| Professional | | $12.88 | $15.14 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $38.90
| Facility | | $19.50 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $19.50
| Professional | | $14.79 | $17.78 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $44.67 / $51.29
| Facility | | $20.42 | $44.67 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $20.42
| Professional | | $10.47 | $10.47 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $75.86
| Professional | | $32.36 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $39.81
| Facility | | $19.50 | $19.50 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $53.70
| Facility | | $19.50 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $23.44
| Professional | | $17.78 | $17.78 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $51.29
| Facility | | $22.39 | $29.51 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $19.50
| Professional | | $14.79 | $17.78 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $23.44
| Facility | | $17.78 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.13 / $19.95
| Professional | | $7.76 | $8.13 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $35.48
| Professional | | $8.71 | $10.23 | $35.48 |