- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $38.90 / $109.65
| Facility | | $15.85 | $38.90 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $25.12
| Professional | | $12.59 | $15.85 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.50 / $11.48
| Professional | | $5.01 | $5.50 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $20.89 / $20.89
| Facility | | $19.95 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $112.20
| Facility | | $21.88 | $43.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $32.36
| Professional | | $11.22 | $13.80 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $52.48
| Facility | | $15.85 | $20.89 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $33.88
| Professional | | $12.02 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $17.78 / $17.78
| Professional | | $15.85 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $61.66
| Facility | | $15.85 | $22.91 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $31.62
| Professional | | $11.22 | $13.80 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $20.89 / $25.12
| Facility | | $8.91 | $20.89 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $11.22 / $20.89
| Professional | | $8.91 | $11.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.96 / $20.89
| Professional | | $8.13 | $10.96 | $20.89 |