- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $54.95 / $85.11
| Facility | | $18.20 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $36.31
| Professional | | $14.13 | $15.85 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $5,011.87
| Facility | | $112.20 | $147.91 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $30.20 / $67.61
| Facility | | $14.13 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $26.92 / $51.29
| Professional | | $12.30 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $28.18
| Professional | | $9.12 | $11.48 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $33.88
| Professional | | $19.50 | $23.44 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $54.95 / $67.61
| Facility | | $15.85 | $54.95 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $25.70
| Professional | | $14.13 | $15.85 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $27.54 / $57.54
| Facility | | $12.02 | $27.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $27.54 / $57.54
| Professional | | $14.45 | $27.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $19.50 / $23.44
| Facility | | $11.75 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $37.15
| Professional | | $8.91 | $14.79 | $37.15 |