- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $95.50 / $309.03
| Facility | | $26.30 | $95.50 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $12.59 / $45.71
| Professional | | $11.22 | $12.59 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $50.12
| Facility | | $28.18 | $45.71 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.05 / $30.90
| Professional | | $8.91 | $19.05 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.02 / $44.67
| Professional | | $35.48 | $38.02 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $177.83
| Facility | | $17.38 | $24.55 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $19.05 / $26.30
| Professional | | $12.59 | $19.05 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $34.67
| Facility | | $17.38 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $25.70
| Professional | | $17.38 | $17.38 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $23.99 / $51.29
| Facility | | $15.49 | $23.99 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $79.43
| Professional | | $15.49 | $19.05 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $70.79
| Facility | | $25.70 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $20.89
| Professional | | $12.88 | $15.85 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $20.89 / $27.54
| Facility | | $8.13 | $20.89 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $20.89
| Professional | | $7.24 | $7.41 | $20.89 |