- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $24.55 / $104.71
| Facility | | $8.71 | $24.55 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $15.14 / $27.54
| Professional | | $12.30 | $15.14 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $12.88
| Professional | | $11.48 | $12.59 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.38 / $25.12
| Facility | | $18.62 | $21.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $21.38
| Professional | | $16.98 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $54.95
| Facility | | $13.80 | $18.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $18.62 / $38.02
| Professional | | $10.72 | $18.62 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $15.85
| Facility | | $10.96 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $21.38
| Professional | | $12.59 | $12.59 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $10.23 / $12.59
| Professional | | $2.51 | $10.23 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $13.49 / $21.38
| Facility | | $8.91 | $13.49 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $9.55 / $28.18
| Professional | | $7.41 | $9.55 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $21.38
| Professional | | $12.59 | $12.59 | $21.38 |