- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $288.40
| Professional | | $30.90 | $30.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $72.44
| Professional | | $4.90 | $4.90 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- 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
- $37.15 / $43.65 / $69.18
| Facility | | $37.15 | $43.65 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $74.13
| Professional | | $16.98 | $21.88 | $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
- $28.18 / $28.18 / $63.10
| Professional | | $28.18 | $28.18 | $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
- $12.30 / $12.30 / $12.30
| Professional | | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $12.30
| Professional | | $12.30 | $12.30 | $12.30 |
- 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 |