- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $50.12 / $173.78
| Facility | | $13.80 | $50.12 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $19.95
| Professional | | $10.00 | $13.49 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $61.66
| Facility | | $35.48 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $10.96 / $13.18
| Professional | | $9.55 | $10.96 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $33.11 / $72.44
| Facility | | $10.96 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.96 / $23.99
| Professional | | $8.13 | $10.96 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $34.67 / $50.12
| Professional | | $13.18 | $34.67 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.45 / $28.18
| Facility | | $12.59 | $14.45 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $46.77 / $52.48
| Professional | | $12.59 | $46.77 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $15.85 / $27.54
| Facility | | $7.94 | $15.85 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $10.23 / $22.39
| Professional | | $6.61 | $10.23 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |