- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $74.13
| Facility | | $18.20 | $29.51 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $25.70
| Professional | | $15.14 | $18.20 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $97.72 / $97.72
| Facility | | $50.12 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $20.42
| Professional | | $10.23 | $14.79 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $46.77 / $102.33
| Facility | | $15.49 | $46.77 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $15.85 / $33.88
| Professional | | $11.48 | $15.85 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $41.69 / $57.54
| Professional | | $18.62 | $41.69 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $20.42 / $43.65
| Facility | | $18.20 | $20.42 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $39.81
| Professional | | $18.20 | $36.31 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $26.92 / $39.81
| Facility | | $11.75 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $35.48
| Professional | | $11.22 | $15.85 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |