- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $141.25
| Professional | | $15.85 | $15.85 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $33.11 / $37.15
| Professional | | $3.02 | $33.11 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $28.84
| Facility | | $21.88 | $21.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $28.84
| Professional | | $18.62 | $18.62 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $37.15
| Facility | | $33.11 | $33.11 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $37.15
| Professional | | $33.11 | $33.11 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $33.88
| Professional | | $22.39 | $28.18 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $29.51 / $32.36
| Facility | | $3.24 | $29.51 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.39 / $33.88
| Professional | | $3.24 | $3.39 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.88 / $28.84
| Facility | | $2.69 | $2.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $5.89 / $29.51
| Professional | | $2.69 | $5.89 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $30.20 / $37.15
| Professional | | $3.02 | $30.20 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $12.59 / $21.38
| Facility | | $1.51 | $12.59 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $29.51
| Professional | | $15.49 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |