- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $70.79
| Facility | | $15.85 | $26.30 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $23.99
| Professional | | $14.13 | $15.85 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $81.28 / $81.28
| Facility | | $46.77 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.02 / $13.80
| Professional | | $9.55 | $12.02 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $43.65 / $95.50
| Facility | | $14.45 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $32.36
| Professional | | $9.77 | $13.80 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $35.48 / $109.65
| Professional | | $15.85 | $35.48 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $37.15
| Facility | | $15.85 | $22.91 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $36.31 / $39.81
| Professional | | $15.14 | $36.31 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $20.89 / $33.11
| Facility | | $10.47 | $20.89 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $26.30
| Professional | | $10.47 | $13.18 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |