- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $52.48 / $64.57
| Facility | | $21.88 | $52.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $95.50
| Professional | | $20.89 | $20.89 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $39.81
| Facility | | $28.18 | $28.18 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $5,011.87
| Facility | | $19.50 | $22.91 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $100.00 / $107.15
| Facility | | $28.18 | $100.00 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $37.15
| Professional | | $31.62 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $257.04
| Facility | | $54.95 | $54.95 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.18 / $33.11
| Facility | | $26.92 | $28.18 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $56.23
| Facility | | $20.89 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $23.44
| Professional | | $20.89 | $20.89 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $24.55 / $53.70
| Facility | | $13.18 | $24.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $24.55 / $53.70
| Professional | | $11.48 | $24.55 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $33.11
| Professional | | $21.38 | $21.38 | $33.11 |