- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $77.62 / $144.54
| Facility | | $19.50 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $41.69
| Professional | | $15.49 | $18.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $12.88
| Professional | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $41.69
| Facility | | $21.88 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $20.89
| Professional | | $15.49 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $44.67 / $67.61
| Facility | | $21.88 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $32.36
| Professional | | $12.88 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $21.88
| Professional | | $13.49 | $18.20 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $42.66
| Facility | | $20.89 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $25.12
| Professional | | $20.89 | $23.99 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $57.54
| Facility | | $20.89 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $25.12
| Professional | | $18.62 | $18.62 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $54.95
| Facility | | $23.99 | $31.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $20.89
| Professional | | $15.49 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $25.12
| Facility | | $18.62 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $28.84
| Professional | | $8.71 | $12.30 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.72 / $37.15
| Professional | | $9.33 | $10.72 | $37.15 |