- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $67.61
| Facility | | $15.85 | $26.92 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $23.99
| Professional | | $14.13 | $15.85 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $75.86
| Facility | | $42.66 | $63.10 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $26.30
| Professional | | $9.12 | $13.18 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $42.66 / $91.20
| Facility | | $14.13 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $30.90
| Professional | | $10.47 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $37.15 / $51.29
| Professional | | $16.60 | $37.15 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $39.81
| Facility | | $16.22 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $30.20
| Professional | | $16.22 | $26.92 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $20.42 / $35.48
| Facility | | $10.72 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $28.18
| Professional | | $10.00 | $14.13 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |