- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $39.81
| Professional | | $18.20 | $23.99 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $91.20 / $109.65
| Professional | | $34.67 | $91.20 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $45.71
| Facility | | $26.92 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $48.98
| Professional | | $33.11 | $35.48 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $45.71
| Facility | | $35.48 | $43.65 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $48.98
| Professional | | $44.67 | $44.67 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $53.70
| Facility | | $23.44 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $42.66 / $74.13
| Professional | | $19.95 | $42.66 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $177.83
| Facility | | $37.15 | $70.79 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $50.12 / $50.12
| Professional | | $45.71 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $67.61
| Facility | | $15.85 | $22.91 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $20.42 / $38.90
| Professional | | $18.20 | $20.42 | $38.90 |