- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $33.88 / $97.72
| Facility | | $12.59 | $33.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $22.91
| Professional | | $10.00 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Professional | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $61.66 / $107.15
| Facility | | $23.99 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.00 / $16.60
| Professional | | $5.01 | $10.00 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $117.49
| Facility | | $16.60 | $26.92 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $20.89
| Facility | | $18.20 | $18.20 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $38.02 / $85.11
| Facility | | $20.42 | $38.02 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.18 / $30.90
| Professional | | $10.23 | $13.18 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $134.90
| Facility | | $87.10 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $53.70
| Facility | | $13.49 | $18.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $32.36
| Professional | | $10.00 | $16.22 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $15.14 / $15.14
| Professional | | $13.49 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.20 / $52.48
| Facility | | $14.45 | $18.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.18 / $30.20
| Professional | | $10.23 | $13.18 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $18.20 / $21.88
| Facility | | $8.13 | $18.20 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.72 / $25.12
| Professional | | $7.59 | $10.72 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.33 / $18.20
| Professional | | $7.08 | $9.33 | $18.20 |