- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $30.20 / $134.90
| Facility | | $12.88 | $30.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $18.62
| Professional | | $10.96 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.48
| Professional | | $11.22 | $11.22 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $18.62 / $21.88
| Facility | | $16.60 | $18.62 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $18.62 / $18.62
| Professional | | $14.79 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $75.86
| Facility | | $9.55 | $14.45 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $18.20 / $28.18
| Professional | | $8.71 | $18.20 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $16.60
| Professional | | $11.22 | $11.22 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $18.62
| Facility | | $7.76 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.76 / $18.62
| Professional | | $6.46 | $7.76 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $18.62
| Professional | | $11.22 | $11.22 | $18.62 |