- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $28.84 / $208.93
| Facility | | $16.98 | $28.84 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $50.12
| Professional | | $10.96 | $21.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Professional | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $48.98
| Facility | | $14.13 | $14.13 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $10.23 / $33.88
| Professional | | $5.89 | $10.23 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $12.30 / $25.12
| Facility | | $11.22 | $12.30 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $67.61
| Facility | | $15.85 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $13.49 / $31.62
| Professional | | $6.92 | $13.49 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $24.55 / $81.28
| Facility | | $12.59 | $24.55 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.51 / $15.49
| Professional | | $5.89 | $8.51 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $14.13 / $16.98
| Facility | | $6.31 | $14.13 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.51 / $16.60
| Professional | | $5.89 | $8.51 | $16.60 |