- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $61.66 / $147.91
| Facility | | $19.50 | $61.66 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $17.38 / $25.12
| Professional | | $14.13 | $17.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.02 / $12.02
| Professional | | $11.75 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $19.50 / $22.91
| Facility | | $17.38 | $19.50 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.50 / $27.54
| Professional | | $15.85 | $19.50 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $23.99 / $50.12
| Facility | | $13.49 | $23.99 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $38.90
| Professional | | $10.47 | $16.98 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $27.54
| Professional | | $11.75 | $11.75 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $9.33 / $12.59
| Professional | | $2.34 | $9.33 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $15.85 / $23.99
| Facility | | $8.32 | $15.85 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.48 / $27.54
| Professional | | $8.32 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $19.50
| Professional | | $12.59 | $12.59 | $19.50 |