- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $147.91
| Facility | | $21.38 | $41.69 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.30 / $67.61
| Professional | | $15.14 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.33
| Professional | | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $64.57
| Facility | | $18.62 | $18.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.60 / $47.86
| Professional | | $9.12 | $16.60 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.02 / $41.69
| Facility | | $34.67 | $38.02 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $104.71
| Facility | | $24.55 | $34.67 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $47.86
| Professional | | $10.00 | $19.05 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $100.00
| Facility | | $16.60 | $32.36 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $23.44
| Professional | | $7.76 | $11.22 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $18.62 / $22.91
| Facility | | $8.32 | $18.62 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $22.39
| Professional | | $7.76 | $11.22 | $22.39 |