- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $64.57
| Facility | | $25.12 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $42.66
| Professional | | $15.14 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $58.88
| Professional | | $11.48 | $11.48 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $22.91 / $22.91
| Facility | | $13.80 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $22.91
| Professional | | $16.98 | $22.91 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $58.88
| Facility | | $37.15 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $30.20 / $100.00
| Professional | | $14.79 | $30.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.50 / $33.11
| Professional | | $16.22 | $19.50 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $22.91 / $40.74
| Professional | | $21.88 | $22.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.84
| Professional | | $22.91 | $22.91 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $22.91 / $45.71
| Professional | | $10.47 | $22.91 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $22.91 / $45.71
| Professional | | $21.88 | $22.91 | $45.71 |