- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $18.62 / $97.72
| Facility | | $6.31 | $18.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $33.88
| Professional | | $15.85 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $22.91 / $58.88
| Professional | | $10.00 | $22.91 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $38.90
| Professional | | $28.84 | $36.31 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $61.66
| Facility | | $24.55 | $24.55 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $24.55
| Professional | | $18.20 | $18.20 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $29.51
| Facility | | $28.84 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $38.90
| Professional | | $16.98 | $23.44 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $30.90 / $31.62
| Professional | | $28.84 | $30.90 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.98 / $46.77
| Facility | | $13.18 | $16.98 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $24.55
| Professional | | $15.14 | $19.05 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $38.90
| Professional | | $20.89 | $20.89 | $38.90 |