- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $40.74 / $141.25
| Facility | | $10.00 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $25.12
| Professional | | $7.94 | $10.00 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $6.76 / $7.76
| Professional | | $5.62 | $6.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.22 / $13.18
| Facility | | $10.00 | $11.22 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.22 / $15.85
| Professional | | $9.33 | $11.22 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $13.80 / $28.84
| Facility | | $7.94 | $13.80 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $11.48 / $22.91
| Professional | | $5.62 | $11.48 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $46.77 / $102.33
| Facility | | $11.22 | $46.77 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $15.85
| Professional | | $6.76 | $6.76 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $5.37 / $6.76
| Professional | | $1.35 | $5.37 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $9.12 / $13.80
| Facility | | $4.68 | $9.12 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.61 / $15.85
| Professional | | $4.68 | $6.61 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $11.22
| Professional | | $6.76 | $6.76 | $11.22 |