- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $51.29 / $87.10
| Facility | | $18.62 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $36.31
| Professional | | $12.88 | $15.85 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $5,011.87
| Facility | | $85.11 | $112.20 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.85
| Professional | | $15.49 | $15.49 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $28.84 / $67.61
| Facility | | $14.13 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $22.91 / $38.02
| Professional | | $9.33 | $22.91 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.75 / $28.84
| Professional | | $9.33 | $11.75 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.95 / $34.67
| Professional | | $16.60 | $19.95 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $41.69 / $67.61
| Facility | | $15.85 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $22.91
| Professional | | $12.88 | $15.85 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $20.89
| Facility | | $13.49 | $20.42 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $22.39
| Professional | | $13.49 | $20.42 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.95 / $23.99
| Facility | | $10.00 | $19.95 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $12.88 / $29.51
| Professional | | $8.32 | $12.88 | $29.51 |