- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.70 / $138.04
| Facility | | $13.49 | $25.70 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $23.99
| Professional | | $10.96 | $14.13 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $61.66 / $61.66
| Facility | | $45.71 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $16.60
| Professional | | $10.00 | $13.18 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $34.67 / $75.86
| Facility | | $11.48 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.72 / $24.55
| Professional | | $7.94 | $10.72 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $31.62 / $45.71
| Professional | | $9.55 | $31.62 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.18 / $28.18
| Facility | | $12.02 | $13.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $6.03
| Professional | | $5.50 | $5.50 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $16.98 / $25.12
| Facility | | $7.59 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $20.42
| Professional | | $7.08 | $10.23 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |