- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $18.20
| Facility | | $15.85 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $21.88
| Professional | | $10.96 | $15.85 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $24.55
| Facility | | $15.49 | $15.49 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $29.51 / $37.15
| Professional | | $15.85 | $29.51 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $37.15
| Professional | | $21.88 | $32.36 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $117.49
| Facility | | $14.79 | $25.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.80 / $36.31
| Professional | | $10.00 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $29.51
| Professional | | $23.99 | $25.12 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $36.31
| Professional | | $21.88 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $10.72 / $18.20
| Facility | | $7.41 | $10.72 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $21.38
| Professional | | $10.00 | $10.96 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $19.50
| Professional | | $15.49 | $19.50 | $19.50 |