- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $81.28 / $263.03
| Facility | | $21.38 | $81.28 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $60.26
| Professional | | $19.05 | $22.39 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $17.78 / $36.31
| Professional | | $7.08 | $17.78 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $114.82
| Facility | | $54.95 | $81.28 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.60 / $23.44
| Professional | | $11.48 | $16.60 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $53.70 / $117.49
| Facility | | $17.78 | $53.70 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.78 / $39.81
| Professional | | $13.18 | $17.78 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $47.86 / $63.10
| Professional | | $21.38 | $47.86 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $22.39 / $50.12
| Facility | | $20.42 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $26.92
| Professional | | $20.89 | $24.55 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $44.67
| Facility | | $12.88 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $18.20 / $36.31
| Professional | | $11.48 | $18.20 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |