- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $204.17
| Facility | | $44.67 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $15.14 / $114.82
| Professional | | $9.55 | $15.14 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $21.38 / $30.90
| Professional | | $14.45 | $21.38 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.72 / $11.75
| Facility | | $10.23 | $10.72 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $16.98
| Professional | | $12.59 | $15.85 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $42.66
| Facility | | $24.55 | $24.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Professional | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $13.49 / $33.88
| Professional | | $6.61 | $13.49 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $15.85
| Facility | | $10.96 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $28.84
| Professional | | $11.22 | $15.85 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $16.22
| Professional | | $12.88 | $12.88 | $16.22 |