- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $141.25
| Professional | | $12.88 | $19.95 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $2.82
| Facility | | $2.82 | $2.82 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $30.20 / $87.10
| Professional | | $14.13 | $30.20 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $107.15
| Facility | | $43.65 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $141.25
| Professional | | $19.95 | $36.31 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $25.12 / $25.70
| Facility | | $24.55 | $25.12 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $44.67
| Professional | | $21.38 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $34.67
| Professional | | $28.84 | $28.84 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $45.71
| Professional | | $22.91 | $26.92 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $181.97
| Facility | | $100.00 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $25.70 / $38.02
| Facility | | $13.80 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $29.51
| Professional | | $21.38 | $25.12 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $30.20
| Professional | | $28.84 | $29.51 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $12.88 / $24.55
| Facility | | $1.48 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.50 / $38.90
| Professional | | $15.14 | $19.50 | $38.90 |