- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $131.83
| Facility | | $14.79 | $25.12 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $42.66
| Professional | | $10.00 | $15.14 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $45.71
| Facility | | $12.88 | $12.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $11.48 / $33.88
| Professional | | $6.46 | $11.48 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $26.30 / $29.51
| Facility | | $24.55 | $26.30 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $70.79
| Facility | | $17.38 | $24.55 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $12.30 / $33.11
| Professional | | $6.92 | $12.30 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $22.39 / $70.79
| Facility | | $11.75 | $22.39 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.76 / $15.85
| Professional | | $5.50 | $7.76 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $12.88 / $15.85
| Facility | | $5.89 | $12.88 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.76 / $15.85
| Professional | | $5.50 | $7.76 | $15.85 |