- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $53.70 / $87.10
| Facility | | $21.38 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $32.36
| Professional | | $12.88 | $15.14 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $5,011.87
| Facility | | $97.72 | $128.82 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $18.20
| Professional | | $14.45 | $14.45 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $28.18 / $63.10
| Facility | | $13.18 | $28.18 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $23.44 / $44.67
| Professional | | $10.72 | $23.44 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $18.20 / $26.92
| Professional | | $8.71 | $18.20 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $20.42 / $31.62
| Professional | | $17.78 | $20.42 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $47.86 / $63.10
| Facility | | $14.79 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $22.91
| Professional | | $12.88 | $15.14 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $23.99 / $81.28
| Facility | | $14.45 | $23.99 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $23.99 / $81.28
| Professional | | $14.45 | $23.99 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $18.20 / $21.88
| Facility | | $10.72 | $18.20 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $13.49 / $34.67
| Professional | | $8.32 | $13.49 | $34.67 |