- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $53.70 / $338.84
| Facility | | $4.47 | $53.70 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $34.67
| Professional | | $12.88 | $15.14 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.96
| Professional | | $10.72 | $10.72 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $17.78 / $20.89
| Facility | | $15.85 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $17.78 / $17.78
| Professional | | $14.45 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $17.38 / $72.44
| Facility | | $12.30 | $17.38 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.98 / $35.48
| Professional | | $9.12 | $16.98 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $22.39
| Professional | | $10.72 | $10.72 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.18 / $19.95
| Facility | | $7.59 | $13.18 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.33 / $22.39
| Professional | | $7.59 | $9.33 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $17.78
| Professional | | $10.72 | $10.72 | $17.78 |