- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $58.88 / $138.04
| Facility | | $15.49 | $58.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.79 / $20.89
| Professional | | $12.30 | $14.79 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $11.48
| Professional | | $10.00 | $11.48 | $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
- $12.30 / $14.79 / $16.60
| Professional | | $12.30 | $14.79 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $52.48
| Facility | | $16.98 | $34.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $17.38 / $26.30
| Professional | | $10.23 | $17.38 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.45 / $17.38
| Professional | | $10.47 | $14.45 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $33.11
| Facility | | $16.60 | $16.60 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $45.71
| Facility | | $16.60 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $19.95
| Professional | | $14.79 | $14.79 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $43.65
| Facility | | $19.05 | $24.55 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.79 / $16.60
| Professional | | $12.30 | $14.79 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $19.95 / $19.95
| Facility | | $14.79 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.55 / $20.89
| Professional | | $6.92 | $9.55 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.51 / $29.51
| Professional | | $7.41 | $8.51 | $29.51 |