- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $63.10 / $123.03
| Facility | | $22.39 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $31.62 / $61.66
| Professional | | $15.14 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Professional | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $64.57
| Facility | | $18.20 | $18.20 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.22 / $47.86
| Professional | | $10.47 | $16.22 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $41.69
| Facility | | $27.54 | $34.67 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $102.33
| Facility | | $23.99 | $34.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $17.38 / $47.86
| Professional | | $9.77 | $17.38 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $87.10
| Facility | | $16.60 | $32.36 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $22.91
| Professional | | $7.76 | $10.96 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $18.20 / $22.91
| Facility | | $8.32 | $18.20 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $22.39
| Professional | | $7.76 | $10.96 | $22.39 |