- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $66.07
| Facility | | $15.85 | $26.30 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $26.30
| Professional | | $14.13 | $16.98 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $89.13
| Facility | | $42.66 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $47.86
| Professional | | $18.20 | $25.70 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $43.65 / $91.20
| Facility | | $16.60 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $14.79 / $40.74
| Professional | | $9.33 | $14.79 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $50.12
| Facility | | $16.22 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $21.38
| Professional | | $19.95 | $19.95 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $34.67
| Facility | | $17.38 | $26.30 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $14.13 / $33.88
| Professional | | $8.51 | $14.13 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $173.78 / $173.78
| Professional | | $162.18 | $173.78 | $173.78 |