- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $54.95 / $117.49
| Facility | | $15.85 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.79 / $25.12
| Professional | | $12.30 | $14.79 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $11.48 / $28.84
| Professional | | $10.96 | $11.48 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $70.79
| Facility | | $36.31 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $14.79 / $19.50
| Professional | | $7.41 | $14.79 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $34.67 / $74.13
| Facility | | $11.48 | $34.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $11.48 / $25.12
| Professional | | $8.51 | $11.48 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.38 / $30.20
| Professional | | $13.80 | $21.38 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $14.79 / $32.36
| Facility | | $13.18 | $14.79 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $22.39 / $24.55
| Professional | | $13.18 | $22.39 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $446.68
| Facility | | $229.09 | $229.09 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $16.60 / $28.84
| Facility | | $8.32 | $16.60 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $11.48 / $22.91
| Professional | | $6.92 | $11.48 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $100.00
| Facility | | $79.43 | $79.43 | $100.00 |