- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $58.88 / $104.71
| Facility | | $16.60 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $21.88
| Professional | | $12.88 | $16.22 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $12.88 / $12.88
| Professional | | $11.22 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $60.26
| Facility | | $33.88 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $12.30 / $16.98
| Professional | | $11.22 | $12.30 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $38.90 / $85.11
| Facility | | $12.88 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $12.88 / $28.18
| Professional | | $9.77 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $36.31 / $69.18
| Professional | | $15.49 | $36.31 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.22 / $36.31
| Facility | | $15.14 | $16.22 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $46.77 / $51.29
| Professional | | $15.14 | $46.77 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $18.62 / $33.11
| Facility | | $9.77 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $13.18 / $26.30
| Professional | | $9.33 | $13.18 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $100.00
| Facility | | $89.13 | $89.13 | $100.00 |