- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $61.66 / $380.19
| Facility | | $15.85 | $61.66 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $23.99
| Professional | | $12.02 | $14.13 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $58.88
| Facility | | $33.11 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $12.30 / $13.18
| Professional | | $8.32 | $12.30 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $38.90 / $85.11
| Facility | | $12.59 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $9.77 / $25.12
| Professional | | $8.71 | $9.77 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $44.67
| Professional | | $11.22 | $26.92 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.49 / $26.92
| Facility | | $11.48 | $13.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $16.60
| Professional | | $12.02 | $14.79 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $18.62 / $23.99
| Facility | | $9.33 | $18.62 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $19.05
| Professional | | $8.32 | $9.33 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |