- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $87.10
| Facility | | $21.38 | $39.81 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $33.11
| Professional | | $18.20 | $21.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $104.71 / $104.71
| Facility | | $44.67 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.60 / $17.38
| Professional | | $12.02 | $16.60 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $54.95 / $120.23
| Facility | | $18.20 | $54.95 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $40.74
| Professional | | $12.88 | $17.78 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $42.66 / $45.71
| Professional | | $17.78 | $42.66 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $22.39 / $47.86
| Facility | | $20.42 | $22.39 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $20.89
| Professional | | $18.62 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $26.92 / $42.66
| Facility | | $12.88 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.38 / $34.67
| Professional | | $12.59 | $17.38 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | | $125.89 | $125.89 | $125.89 |