- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $42.66 / $112.20
| Facility | | $15.85 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $20.89
| Professional | | $7.76 | $10.96 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $43.65
| Facility | | $19.50 | $31.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $43.65
| Professional | | $17.38 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $64.57 / $72.44
| Professional | | $58.88 | $64.57 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $74.13
| Facility | | $12.02 | $14.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.60 / $25.12
| Professional | | $12.02 | $16.60 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.49 / $35.48
| Facility | | $12.02 | $13.49 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $37.15
| Professional | | $12.02 | $18.62 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $19.50 / $43.65
| Facility | | $14.45 | $19.50 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $43.65
| Professional | | $12.02 | $16.98 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $50.12
| Facility | | $18.20 | $36.31 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.30 / $15.49
| Professional | | $9.12 | $12.30 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $14.45 / $19.50
| Facility | | $7.59 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.92 / $16.98
| Professional | | $5.01 | $6.92 | $16.98 |