- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $63.10 / $102.33
| Facility | | $21.88 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $41.69
| Professional | | $15.85 | $19.05 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $5,011.87
| Facility | | $117.49 | $158.49 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $23.44
| Professional | | $18.20 | $18.20 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $35.48 / $79.43
| Facility | | $16.60 | $35.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.02 / $72.44
| Professional | | $19.05 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $22.91 / $33.11
| Professional | | $10.96 | $22.91 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $39.81
| Professional | | $22.91 | $25.12 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $58.88 / $79.43
| Facility | | $18.62 | $58.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.20 / $28.18
| Professional | | $16.98 | $18.20 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $25.70 / $41.69
| Facility | | $5.50 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $23.99 / $32.36
| Professional | | $5.50 | $23.99 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $22.91 / $27.54
| Facility | | $10.23 | $22.91 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.13 / $38.90
| Professional | | $9.77 | $14.13 | $38.90 |