- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $67.61 / $186.21
| Facility | | $20.89 | $67.61 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $21.88 / $47.86
| Professional | | $7.94 | $21.88 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $114.82
| Facility | | $44.67 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.95 / $21.38
| Professional | | $13.80 | $19.95 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $24.55 / $30.90
| Professional | | $14.79 | $24.55 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $131.83 / $204.17
| Facility | | $7.76 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.76 / $14.13
| Professional | | $5.75 | $7.76 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $26.92
| Professional | | $15.85 | $15.85 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Facility | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $7.76 / $17.38
| Facility | | $5.37 | $7.76 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.76 / $14.13
| Professional | | $7.41 | $7.76 | $14.13 |