- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $125.89 / $173.78
| Facility | | $16.60 | $125.89 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $19.95 / $48.98
| Professional | | $5.01 | $19.95 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $11.22
| Professional | | $3.80 | $3.80 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $54.95
| Facility | | $19.05 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $12.30
| Professional | | $8.13 | $11.75 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $14.45 / $18.20
| Professional | | $4.68 | $14.45 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $112.20 / $165.96
| Facility | | $11.48 | $112.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.47 / $13.80
| Professional | | $3.39 | $4.47 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $9.12
| Professional | | $9.12 | $9.12 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $9.12
| Facility | | $9.12 | $9.12 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,290.87
| Facility | | $1,949.84 | $1,949.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $4.47 / $10.00
| Facility | | $3.16 | $4.47 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.47 / $8.32
| Professional | | $4.27 | $4.47 | $8.32 |