- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $52.48
| Professional | | $10.00 | $12.02 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $25.12 / $45.71
| Professional | | $14.13 | $25.12 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $74.13
| Facility | | $61.66 | $61.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $27.54 / $38.02
| Professional | | $10.47 | $27.54 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $42.66
| Facility | | $10.23 | $14.79 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $38.90
| Professional | | $25.12 | $30.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.79 / $42.66
| Facility | | $9.77 | $14.79 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $1,905.46
| Professional | | $12.88 | $19.95 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $70.79
| Professional | | $32.36 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $53.70 / $83.18
| Professional | | $26.92 | $53.70 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $47.86
| Professional | | $16.22 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $1,071.52 / $1,949.84
| Professional | | $22.39 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.62 / $34.67
| Professional | | $16.98 | $18.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $83.18
| Professional | | $12.02 | $17.38 | $83.18 |