- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $61.66 / $154.88
| Facility | | $16.60 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $38.90
| Professional | | $15.14 | $19.05 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $14.45 / $29.51
| Professional | | $5.75 | $14.45 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $46.77 / $66.07
| Facility | | $43.65 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $13.49 / $14.45
| Professional | | $9.33 | $13.49 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $42.66 / $95.50
| Facility | | $14.45 | $42.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $31.62
| Professional | | $10.72 | $14.45 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $38.90 / $75.86
| Professional | | $17.38 | $38.90 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.05 / $30.90
| Facility | | $16.60 | $19.05 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $22.39 / $25.12
| Professional | | $16.60 | $22.39 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $501.19
| Facility | | $251.19 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $20.89 / $36.31
| Facility | | $10.96 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $11.48 / $28.84
| Professional | | $10.47 | $11.48 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |