- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $75.86
| Facility | | $18.20 | $24.55 | $75.86 |
- 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
- $51.29 / $74.13 / $74.13
| Facility | | $51.29 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.72 / $14.79
| Professional | | $10.23 | $10.72 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $47.86 / $104.71
| Facility | | $15.85 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $12.59 / $30.90
| Professional | | $10.72 | $12.59 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $95.50
| Professional | | $14.13 | $14.13 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $33.88
| Facility | | $13.80 | $16.60 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $31.62 / $34.67
| Professional | | $14.79 | $31.62 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $22.91 / $30.20
| Facility | | $11.48 | $22.91 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.30 / $24.55
| Professional | | $10.23 | $12.30 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $117.49
| Facility | | $109.65 | $109.65 | $117.49 |