- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $107.15
| Facility | | $30.20 | $44.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.89 / $35.48
| Professional | | $12.88 | $20.89 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $69.18
| Facility | | $38.90 | $63.10 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $26.30 / $42.66
| Professional | | $12.02 | $26.30 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $52.48 / $61.66
| Professional | | $48.98 | $52.48 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $23.99 / $52.48
| Facility | | $22.91 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $35.48
| Professional | | $23.99 | $28.84 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $47.86
| Facility | | $23.99 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $28.84
| Professional | | $23.99 | $23.99 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $69.18
| Facility | | $20.42 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $79.43
| Professional | | $21.88 | $26.30 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $100.00
| Facility | | $36.31 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $28.84
| Professional | | $18.20 | $21.88 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $28.84 / $38.90
| Facility | | $10.96 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $28.84
| Professional | | $10.00 | $10.00 | $28.84 |