- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $263.03 / $263.03
| Professional | | $25.70 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $70.79
| Professional | | $4.37 | $4.37 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $81.28
| Facility | | $43.65 | $50.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $74.13
| Professional | | $19.95 | $25.70 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $43.65
| Facility | | $16.22 | $16.22 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.22 / $112.20
| Facility | | $8.13 | $16.22 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.13 / $42.66
| Professional | | $11.48 | $14.13 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $85.11
| Professional | | $50.12 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $54.95 / $79.43
| Professional | | $31.62 | $54.95 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $151.36
| Facility | | $50.12 | $50.12 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.45 / $23.99
| Facility | | $12.02 | $14.45 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $41.69
| Professional | | $10.00 | $14.13 | $41.69 |