- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $48.98 / $204.17
| Facility | | $10.47 | $48.98 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $38.90
| Professional | | $21.88 | $25.70 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $19.50
| Professional | | $17.78 | $17.78 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $34.67
| Facility | | $17.78 | $29.51 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $18.62 / $29.51
| Professional | | $17.38 | $18.62 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $75.86
| Facility | | $20.42 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $87.10
| Professional | | $22.39 | $38.02 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $30.90 / $30.90
| Facility | | $29.51 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $40.74
| Professional | | $17.78 | $17.78 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $17.78 / $33.11
| Professional | | $3.55 | $17.78 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $17.78 / $36.31
| Facility | | $8.51 | $17.78 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $17.38 / $40.74
| Professional | | $10.23 | $17.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $29.51
| Professional | | $17.78 | $17.78 | $29.51 |