- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $58.88 / $120.23
| Facility | | $20.89 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $70.79
| Professional | | $7.94 | $10.00 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $25.12 / $53.70
| Facility | | $6.17 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $12.88 / $64.57
| Professional | | $5.25 | $12.88 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $75.86 / $169.82
| Facility | | $24.55 | $75.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $12.02 / $34.67
| Professional | | $8.51 | $12.02 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $18.62 / $38.90
| Facility | | $8.13 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $12.88 / $24.55
| Professional | | $6.76 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $100.00
| Professional | | $10.72 | $10.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.72 / $66.07
| Professional | | $8.51 | $10.72 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $35.48
| Facility | | $8.91 | $12.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $10.72 / $24.55
| Professional | | $6.31 | $10.72 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.96 / $18.20
| Professional | | $8.51 | $10.96 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $7.41 / $10.72
| Facility | | $4.79 | $7.41 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.46 / $21.88
| Professional | | $4.47 | $6.46 | $21.88 |