- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $72.44
| Facility | | $16.98 | $24.55 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $25.12
| Professional | | $14.13 | $16.98 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $75.86
| Facility | | $46.77 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.50 / $43.65
| Professional | | $16.60 | $19.50 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $45.71 / $100.00
| Facility | | $14.79 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $29.51
| Professional | | $10.23 | $12.59 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $58.88
| Professional | | $14.79 | $14.79 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $34.67
| Facility | | $13.18 | $16.60 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $20.89
| Professional | | $14.13 | $19.05 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $30.90
| Facility | | $10.96 | $21.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $25.12
| Professional | | $10.23 | $12.59 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |