- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $70.79 / $123.03
| Facility | | $28.18 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $37.15
| Professional | | $13.80 | $16.60 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $66.07
| Facility | | $30.20 | $47.86 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $20.42 / $34.67
| Professional | | $12.59 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $46.77
| Professional | | $37.15 | $40.74 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $42.66 / $114.82
| Facility | | $18.20 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $22.39 / $34.67
| Professional | | $16.60 | $22.39 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $37.15
| Facility | | $18.20 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $22.91
| Professional | | $18.20 | $18.20 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $54.95
| Facility | | $17.78 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $79.43
| Professional | | $18.20 | $22.91 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $54.95 / $75.86
| Facility | | $27.54 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $23.44
| Professional | | $13.80 | $18.62 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $21.88 / $29.51
| Facility | | $11.48 | $21.88 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $27.54
| Professional | | $7.76 | $10.47 | $27.54 |