- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $58.88 / $107.15
| Facility | | $15.14 | $58.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $23.44
| Professional | | $10.96 | $15.85 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.80 / $13.80
| Professional | | $12.02 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $117.49
| Facility | | $26.30 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.96 / $19.05
| Professional | | $5.01 | $10.96 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $100.00
| Facility | | $93.33 | $93.33 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $19.95
| Facility | | $17.78 | $17.78 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $104.71
| Facility | | $22.91 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $33.11
| Professional | | $11.22 | $14.45 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $100.00
| Facility | | $93.33 | $93.33 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $19.95 / $89.13
| Facility | | $14.79 | $19.95 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $17.78 / $35.48
| Professional | | $10.96 | $17.78 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $16.60
| Professional | | $14.79 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $57.54
| Facility | | $15.85 | $19.95 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $33.11
| Professional | | $11.22 | $14.45 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.95 / $23.44
| Facility | | $8.91 | $19.95 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.48 / $19.95
| Professional | | $8.32 | $11.48 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.23 / $19.95
| Professional | | $7.76 | $10.23 | $19.95 |