- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $81.28 / $194.98
| Facility | | $19.05 | $81.28 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $19.05
| Professional | | $10.00 | $12.02 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $38.02
| Facility | | $29.51 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $54.95
| Professional | | $6.76 | $6.76 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $14.45
| Facility | | $10.96 | $10.96 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $13.80
| Professional | | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $70.79
| Facility | | $38.02 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $20.42 / $69.18
| Professional | | $15.85 | $20.42 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $40.74 / $109.65
| Facility | | $12.30 | $40.74 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.98 / $109.65
| Facility | | $11.22 | $16.98 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.22 / $33.88
| Professional | | $8.13 | $11.22 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $33.11 / $85.11
| Professional | | $13.80 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $38.90
| Facility | | $16.60 | $16.60 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $22.39 / $38.90
| Professional | | $10.23 | $22.39 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $34.67 / $79.43
| Professional | | $18.20 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $109.65
| Facility | | $28.84 | $28.84 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $8.91 / $13.18
| Professional | | $7.24 | $8.91 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $29.51
| Professional | | $19.05 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $39.81 / $75.86
| Professional | | $19.05 | $39.81 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $12.30 / $16.60
| Facility | | $6.92 | $12.30 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.96 / $37.15
| Professional | | $5.75 | $10.96 | $37.15 |