- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $44.67 / $204.17
| Facility | | $16.98 | $44.67 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $46.77
| Professional | | $12.88 | $15.49 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $75.86
| Facility | | $17.78 | $17.78 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $13.80
| Professional | | $8.91 | $8.91 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $34.67 / $81.28
| Facility | | $12.59 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $12.30 / $26.92
| Professional | | $9.77 | $12.30 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.38 / $26.30
| Professional | | $17.78 | $21.38 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $17.78
| Facility | | $15.49 | $15.49 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $38.02
| Professional | | $14.45 | $14.45 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.88 / $45.71
| Facility | | $13.80 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.88 / $45.71
| Professional | | $13.80 | $21.88 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $17.78 / $26.30
| Facility | | $7.59 | $17.78 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.33 / $17.78
| Professional | | $7.59 | $9.33 | $17.78 |