- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $177.83
| Facility | | $26.30 | $36.31 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $22.91 / $87.10
| Professional | | $7.94 | $22.91 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $77.62
| Facility | | $30.20 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $21.88
| Professional | | $14.13 | $20.42 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $31.62
| Professional | | $15.14 | $25.70 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $17.38 / $169.82
| Facility | | $7.94 | $17.38 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $14.45
| Professional | | $6.03 | $7.94 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $27.54
| Professional | | $16.22 | $16.22 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Facility | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.94 / $17.78
| Facility | | $5.62 | $7.94 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.94 / $14.45
| Professional | | $7.59 | $7.94 | $14.45 |