- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $194.98
| Facility | | $20.89 | $38.02 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $28.84 / $58.88
| Professional | | $15.85 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $75.86
| Facility | | $21.88 | $21.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $18.20 / $56.23
| Professional | | $10.72 | $18.20 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $45.71
| Facility | | $33.88 | $36.31 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $120.23
| Facility | | $28.84 | $40.74 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $20.42 / $56.23
| Professional | | $11.48 | $20.42 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $35.48 / $104.71
| Facility | | $19.50 | $35.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $26.30
| Professional | | $9.12 | $13.18 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $21.88 / $26.92
| Facility | | $9.77 | $21.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $26.30
| Professional | | $9.12 | $13.18 | $26.30 |