- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $57.54 / $199.53
| Facility | | $14.13 | $57.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $30.20
| Professional | | $10.96 | $14.45 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $11.22 / $36.31
| Professional | | $9.55 | $11.22 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $69.18 / $69.18
| Facility | | $35.48 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $10.47 / $14.45
| Professional | | $7.24 | $10.47 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $33.88 / $72.44
| Facility | | $11.22 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.22 / $23.99
| Professional | | $8.13 | $11.22 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $29.51 / $56.23
| Professional | | $13.18 | $29.51 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $14.13 / $31.62
| Facility | | $12.88 | $14.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $50.12 / $56.23
| Professional | | $12.88 | $50.12 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $316.23
| Facility | | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $16.22 / $28.18
| Facility | | $7.94 | $16.22 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $22.39
| Professional | | $6.76 | $11.22 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | | $125.89 | $125.89 | $125.89 |