- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $41.69 / $165.96
| Facility | | $12.30 | $41.69 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $25.70 / $44.67
| Professional | | $12.02 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $19.05
| Professional | | $18.62 | $18.62 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $36.31
| Facility | | $27.54 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $30.90
| Professional | | $21.38 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $79.43
| Facility | | $20.89 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $61.66
| Professional | | $16.60 | $32.36 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $63.10 / $138.04
| Facility | | $15.14 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $28.18
| Professional | | $18.62 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $12.88 / $16.22
| Professional | | $3.24 | $12.88 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.18 / $38.02
| Facility | | $12.88 | $28.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $13.49 / $41.69
| Professional | | $8.71 | $13.49 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $30.90
| Professional | | $16.22 | $16.22 | $30.90 |