- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $29.51 / $141.25
| Facility | | $12.88 | $29.51 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $16.98
| Professional | | $12.88 | $12.88 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $25.70
| Professional | | $15.14 | $15.14 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $39.81
| Professional | | $22.91 | $26.30 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $38.02
| Facility | | $21.38 | $28.84 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $36.31
| Professional | | $12.88 | $12.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $12.88 / $32.36
| Facility | | $0.76 | $12.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.20 / $34.67
| Facility | | $14.45 | $18.20 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.20 / $34.67
| Professional | | $14.45 | $18.20 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $29.51 / $38.02
| Facility | | $15.85 | $29.51 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.88 / $22.39
| Professional | | $12.59 | $12.88 | $22.39 |