- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $54.95 / $199.53
| Facility | | $20.42 | $54.95 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $27.54 / $107.15
| Professional | | $14.13 | $27.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $8.51 / $8.51
| Professional | | $7.24 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $58.88
| Facility | | $16.98 | $16.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.13 / $43.65
| Professional | | $8.32 | $14.13 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $38.02
| Facility | | $25.70 | $32.36 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $95.50
| Facility | | $22.39 | $31.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.22 / $43.65
| Professional | | $9.12 | $16.22 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $29.51 / $120.23
| Facility | | $15.14 | $29.51 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $21.38
| Professional | | $7.08 | $10.23 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $16.98 / $20.89
| Facility | | $7.59 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $20.42
| Professional | | $7.08 | $10.23 | $20.42 |