- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $77.62 / $165.96
| Facility | | $17.38 | $77.62 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.98 / $52.48
| Professional | | $13.80 | $16.98 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $12.88 / $41.69
| Professional | | $5.01 | $12.88 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $58.88
| Facility | | $30.90 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $12.02 / $16.60
| Professional | | $8.32 | $12.02 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $38.02 / $83.18
| Facility | | $12.88 | $38.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.88 / $28.18
| Professional | | $9.55 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $25.12
| Professional | | $17.38 | $25.12 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $15.85 / $36.31
| Facility | | $14.79 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $30.20 / $33.88
| Professional | | $14.79 | $30.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $147.91
| Facility | | $72.44 | $72.44 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $18.20 / $32.36
| Facility | | $9.77 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $25.70
| Professional | | $9.12 | $12.88 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |