- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $43.65 / $165.96
| Facility | | $11.75 | $43.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $21.88
| Professional | | $10.96 | $12.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $10.23 / $10.23
| Professional | | $9.77 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $63.10 / $63.10
| Facility | | $32.36 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $13.18
| Professional | | $6.61 | $9.55 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $30.20 / $66.07
| Facility | | $10.00 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.00 / $22.39
| Professional | | $7.59 | $10.00 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $26.92 / $36.31
| Professional | | $12.02 | $26.92 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.59 / $28.84
| Facility | | $11.75 | $12.59 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $16.60
| Professional | | $11.75 | $14.79 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $14.45 / $25.70
| Facility | | $7.59 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $20.42
| Professional | | $7.24 | $10.23 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $100.00
| Facility | | $74.13 | $74.13 | $100.00 |