- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $66.07 / $138.04
| Facility | | $19.05 | $66.07 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $30.20
| Professional | | $13.80 | $16.60 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $11.22 / $33.88
| Professional | | $10.47 | $11.22 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $26.92 / $37.15
| Facility | | $19.50 | $26.92 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $18.20
| Professional | | $13.80 | $16.60 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $40.74 / $58.88
| Facility | | $19.05 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $19.50 / $28.84
| Professional | | $11.48 | $19.50 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.22 / $19.50
| Professional | | $11.75 | $16.22 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $37.15
| Facility | | $18.20 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $21.88
| Professional | | $18.20 | $18.20 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $50.12
| Facility | | $18.20 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $21.88
| Professional | | $16.60 | $16.60 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $48.98
| Facility | | $21.38 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $18.20
| Professional | | $13.80 | $16.60 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $21.88
| Facility | | $16.60 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.72 / $25.70
| Professional | | $7.76 | $10.72 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $9.55 / $33.11
| Professional | | $8.32 | $9.55 | $33.11 |