- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $42.66
| Facility | | $20.89 | $37.15 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $36.31
| Professional | | $14.13 | $19.05 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $75.86
| Facility | | $21.88 | $21.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.50 / $47.86
| Professional | | $10.00 | $19.50 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $22.91 / $26.30
| Facility | | $21.88 | $22.91 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $30.90
| Professional | | $15.49 | $21.88 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $112.20
| Facility | | $26.30 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $17.38 / $81.28
| Professional | | $10.47 | $17.38 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $186.21
| Facility | | $19.05 | $32.36 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.60 / $181.97
| Professional | | $9.12 | $16.60 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $26.30
| Facility | | $10.96 | $21.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $29.51
| Professional | | $9.12 | $13.18 | $29.51 |