- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $28.18 / $128.82
| Facility | | $10.00 | $28.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $18.20 / $44.67
| Professional | | $3.98 | $18.20 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $52.48
| Facility | | $19.05 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $10.47 / $11.22
| Professional | | $7.41 | $10.47 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $13.18 / $16.22
| Professional | | $7.76 | $13.18 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $13.18 / $123.03
| Facility | | $4.07 | $13.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.07 / $7.59
| Professional | | $3.09 | $4.07 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $14.13
| Professional | | $8.32 | $8.32 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $8.32
| Facility | | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.07 / $9.12
| Facility | | $2.88 | $4.07 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.07 / $7.59
| Professional | | $3.89 | $4.07 | $7.59 |