- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $70.79 / $112.20
| Facility | | $26.92 | $70.79 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.89 / $46.77
| Professional | | $19.05 | $20.89 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $181.97 / $5,011.87
| Facility | | $138.04 | $181.97 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $25.70
| Professional | | $19.95 | $19.95 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $38.90 / $89.13
| Facility | | $18.62 | $38.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $63.10
| Professional | | $15.14 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $37.15
| Professional | | $12.02 | $15.14 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $44.67
| Professional | | $25.12 | $28.84 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $67.61 / $89.13
| Facility | | $20.89 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.89 / $32.36
| Professional | | $19.05 | $20.89 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $26.92 / $26.92
| Facility | | $25.70 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $26.30 / $26.92
| Professional | | $12.59 | $26.30 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $30.90
| Facility | | $15.14 | $25.70 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $44.67
| Professional | | $10.96 | $16.98 | $44.67 |