- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $53.70 / $109.65
| Facility | | $15.49 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $23.44
| Professional | | $12.02 | $14.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $19.95
| Facility | | $14.79 | $16.98 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $23.99
| Professional | | $14.13 | $16.98 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $20.42 / $43.65
| Facility | | $11.75 | $20.42 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $17.38 / $33.88
| Professional | | $8.91 | $17.38 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $72.44 / $158.49
| Facility | | $16.98 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $23.44
| Professional | | $10.23 | $10.23 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $8.13 / $10.23
| Professional | | $2.04 | $8.13 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $20.89
| Facility | | $7.08 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $23.44
| Professional | | $7.08 | $10.00 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $16.98
| Professional | | $10.23 | $10.23 | $16.98 |