- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $41.69 / $109.65
| Facility | | $16.98 | $41.69 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.85 / $48.98
| Professional | | $13.80 | $15.85 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.18 / $13.18
| Professional | | $11.48 | $13.18 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $67.61
| Facility | | $35.48 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.80 / $14.13
| Professional | | $9.55 | $13.80 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $43.65 / $95.50
| Facility | | $14.45 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $11.22 / $28.18
| Professional | | $9.77 | $11.22 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.84 / $29.51
| Professional | | $12.88 | $28.84 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $30.20
| Facility | | $12.88 | $15.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $12.59
| Professional | | $11.48 | $11.48 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $467.74
| Facility | | $275.42 | $275.42 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $20.89 / $26.92
| Facility | | $8.91 | $20.89 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $11.22 / $22.39
| Professional | | $8.91 | $11.22 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |