- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $131.83 / $812.83
| Facility | | $13.80 | $131.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $17.78 / $95.50
| Professional | | $8.71 | $17.78 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.13 / $5.25
| Professional | | $4.47 | $5.13 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $37.15
| Facility | | $10.47 | $10.47 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $9.33 / $27.54
| Professional | | $6.03 | $9.33 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $23.99
| Facility | | $15.85 | $19.95 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $58.88
| Facility | | $14.13 | $19.95 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $10.00 / $37.15
| Professional | | $5.62 | $10.00 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $100.00 / $489.78
| Facility | | $12.59 | $100.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.31 / $12.88
| Professional | | $4.47 | $6.31 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $10.47 / $13.18
| Facility | | $4.79 | $10.47 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.31 / $14.79
| Professional | | $4.47 | $6.31 | $14.79 |