- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $107.15
| Facility | | $15.14 | $26.92 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $25.70
| Professional | | $12.88 | $16.98 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $85.11
| Facility | | $40.74 | $60.26 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $21.38
| Professional | | $8.71 | $12.59 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $40.74 / $89.13
| Facility | | $13.49 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $29.51
| Professional | | $10.00 | $13.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $36.31 / $40.74
| Professional | | $16.22 | $36.31 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $17.78 / $38.02
| Facility | | $15.49 | $17.78 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $19.95
| Professional | | $15.49 | $18.20 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $19.50 / $33.88
| Facility | | $10.23 | $19.50 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $13.49 / $26.92
| Professional | | $9.77 | $13.49 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $100.00
| Facility | | $93.33 | $93.33 | $100.00 |