- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $38.02 / $125.89
| Facility | | $14.45 | $38.02 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $15.14 / $67.61
| Professional | | $10.23 | $15.14 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Professional | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $54.95 / $107.15
| Facility | | $20.42 | $54.95 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.22 / $20.42
| Professional | | $5.01 | $11.22 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $20.42
| Facility | | $19.95 | $19.95 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $37.15 / $91.20
| Facility | | $10.96 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.47 / $29.51
| Professional | | $5.75 | $10.47 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $100.00
| Facility | | $97.72 | $97.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $42.66
| Facility | | $13.49 | $20.42 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $30.20
| Professional | | $10.96 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $17.38 / $17.38
| Professional | | $15.49 | $17.38 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $20.42 / $51.29
| Facility | | $12.30 | $20.42 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.47 / $21.88
| Professional | | $5.75 | $10.47 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $20.42 / $24.55
| Facility | | $6.76 | $20.42 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $8.51 / $12.59
| Professional | | $5.13 | $8.51 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.72 / $20.42
| Professional | | $7.94 | $10.72 | $20.42 |