- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $79.43 / $131.83
| Facility | | $16.22 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $21.38 / $60.26
| Professional | | $7.08 | $21.38 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $13.18 / $19.95
| Professional | | $4.90 | $13.18 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $77.62
| Facility | | $19.05 | $36.31 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $15.85
| Professional | | $10.47 | $15.14 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $18.62 / $23.44
| Professional | | $6.03 | $18.62 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $61.66 / $100.00
| Facility | | $12.59 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $7.94 / $17.78
| Professional | | $4.79 | $7.94 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $660.69
| Facility | | $562.34 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.89 / $12.88
| Facility | | $4.07 | $5.89 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.89 / $19.50
| Professional | | $5.50 | $5.89 | $19.50 |