- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $346.74
| Professional | | $204.17 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $70.79
| Professional | | $5.62 | $5.62 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $30.20
| Facility | | $16.22 | $19.05 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $11.22 / $74.13
| Professional | | $7.41 | $11.22 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $43.65
| Facility | | $13.80 | $13.80 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $112.20
| Facility | | $7.59 | $13.80 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $42.66
| Professional | | $12.02 | $14.13 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $85.11
| Professional | | $50.12 | $81.28 | $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
- $14.13 / $14.13 / $14.13
| Professional | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Professional | | $14.13 | $14.13 | $14.13 |
- 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 |