- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $58.88 / $154.88
| Facility | | $16.60 | $58.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $19.95
| Professional | | $12.88 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $11.48
| Professional | | $10.00 | $10.00 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $33.11
| Facility | | $17.38 | $24.55 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $16.60
| Professional | | $12.59 | $15.14 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $37.15 / $53.70
| Facility | | $17.38 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $17.78 / $26.30
| Professional | | $10.47 | $17.78 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $64.57
| Professional | | $10.72 | $14.79 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $33.88
| Facility | | $16.60 | $16.60 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $18.20
| Professional | | $16.60 | $16.60 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $29.51 / $45.71
| Facility | | $16.60 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $19.95
| Professional | | $15.14 | $15.14 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $44.67
| Facility | | $19.05 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $16.60
| Professional | | $12.59 | $15.14 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $19.95
| Facility | | $15.14 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $21.38
| Professional | | $7.08 | $9.77 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.71 / $30.20
| Professional | | $7.59 | $8.71 | $30.20 |