- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $50.12 / $112.20
| Facility | | $14.45 | $50.12 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $30.90
| Professional | | $12.88 | $15.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $12.02
| Professional | | $10.72 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $21.38
| Facility | | $15.85 | $18.20 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $24.55
| Professional | | $15.14 | $18.20 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.38 / $46.77
| Facility | | $12.59 | $21.38 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $19.05 / $36.31
| Professional | | $9.55 | $19.05 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $72.44 / $158.49
| Facility | | $17.38 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $24.55
| Professional | | $10.72 | $10.72 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $8.71 / $10.72
| Professional | | $2.19 | $8.71 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $14.79 / $22.39
| Facility | | $7.59 | $14.79 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.23 / $25.12
| Professional | | $7.59 | $10.23 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $18.20
| Professional | | $10.72 | $10.72 | $18.20 |