- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $89.13
| Facility | | $25.12 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $89.13
| Professional | | $20.89 | $37.15 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $151.36
| Facility | | $17.78 | $29.51 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $125.89
| Professional | | $25.12 | $44.67 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $61.66
| Facility | | $26.92 | $26.92 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $85.11
| Professional | | $26.92 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $81.28
| Professional | | $25.12 | $44.67 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $18.62 / $34.67
| Facility | | $10.47 | $18.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $66.07
| Professional | | $20.42 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $97.72
| Professional | | $24.55 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $81.28
| Professional | | $42.66 | $63.10 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $151.36
| Facility | | $17.78 | $29.51 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $125.89
| Professional | | $25.12 | $44.67 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $75.86
| Professional | | $27.54 | $40.74 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Facility | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $100.00
| Professional | | $25.70 | $47.86 | $100.00 |