- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $37.15 / $141.25
| Facility | | $12.88 | $37.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.45 / $30.20
| Professional | | $12.02 | $14.45 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $11.22 / $11.22
| Professional | | $9.77 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $72.44
| Facility | | $27.54 | $36.31 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $10.47 / $14.79
| Professional | | $7.24 | $10.47 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $33.88 / $74.13
| Facility | | $11.22 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $24.55
| Professional | | $8.32 | $11.22 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $30.20 / $45.71
| Professional | | $13.49 | $30.20 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $14.13 / $31.62
| Facility | | $12.88 | $14.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $21.88
| Professional | | $13.18 | $19.50 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $16.22 / $28.18
| Facility | | $8.51 | $16.22 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $22.91
| Professional | | $8.13 | $11.48 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $100.00
| Facility | | $77.62 | $77.62 | $100.00 |