- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $67.61 / $204.17
| Facility | | $21.88 | $67.61 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $28.84
| Professional | | $10.00 | $12.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $22.39
| Facility | | $16.22 | $16.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $23.44 / $23.44
| Professional | | $16.22 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Facility | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $14.13
| Professional | | $9.12 | $9.12 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $19.05 / $37.15
| Facility | | $11.22 | $19.05 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $15.85 / $22.39
| Professional | | $8.32 | $15.85 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.22 / $33.88
| Professional | | $13.80 | $16.22 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $16.22
| Facility | | $9.12 | $14.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $23.99
| Professional | | $6.03 | $8.51 | $23.99 |