- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $66.07 / $169.82
| Facility | | $20.42 | $66.07 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $16.98 / $28.84
| Professional | | $8.91 | $16.98 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Professional | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $23.99 / $28.18
| Facility | | $21.38 | $23.99 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $23.99
| Professional | | $15.85 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $61.66
| Facility | | $13.49 | $19.50 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $19.95 / $43.65
| Professional | | $11.48 | $19.95 | $43.65 |
- 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
- $14.45 / $14.45 / $21.88
| Professional | | $14.45 | $14.45 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $11.48 / $14.45
| Professional | | $2.88 | $11.48 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $23.99
| Facility | | $10.00 | $14.45 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.00 / $24.55
| Professional | | $6.46 | $10.00 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $23.99
| Professional | | $14.45 | $14.45 | $23.99 |