- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $42.66 / $128.82
| Facility | | $14.45 | $42.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $36.31
| Professional | | $15.49 | $18.20 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.88
| Professional | | $12.59 | $12.59 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $24.55
| Facility | | $18.20 | $20.89 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $28.84
| Professional | | $16.60 | $20.89 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $53.70
| Facility | | $14.45 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $41.69
| Professional | | $10.96 | $21.88 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $85.11 / $186.21
| Facility | | $20.42 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $28.18
| Professional | | $12.59 | $12.59 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $10.00 / $12.59
| Professional | | $2.51 | $10.00 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.98 / $25.70
| Facility | | $8.71 | $16.98 | $25.70 |
- 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
- $12.59 / $12.59 / $20.89
| Professional | | $12.59 | $12.59 | $20.89 |