- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $42.66 / $138.04
| Facility | | $10.96 | $42.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $20.89
| Professional | | $10.00 | $11.48 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.91 / $10.72
| Professional | | $7.76 | $8.91 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $56.23
| Facility | | $21.88 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $11.75
| Professional | | $8.32 | $8.32 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $26.92 / $58.88
| Facility | | $8.91 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $10.23 / $19.95
| Professional | | $6.76 | $10.23 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $23.99 / $25.70
| Professional | | $10.72 | $23.99 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $11.22 / $25.12
| Facility | | $10.23 | $11.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $9.12
| Professional | | $8.13 | $8.13 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $12.88 / $22.39
| Facility | | $6.46 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $17.78
| Professional | | $7.76 | $12.59 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $100.00
| Facility | | $69.18 | $69.18 | $100.00 |