- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $85.11 / $199.53
| Facility | | $22.39 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $95.50
| Professional | | $10.00 | $14.45 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $9.77 / $22.91
| Professional | | $7.24 | $9.77 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $33.88 / $72.44
| Facility | | $8.32 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $12.88 / $40.74
| Professional | | $7.24 | $12.88 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $229.09
| Facility | | $33.88 | $89.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.60 / $47.86
| Professional | | $11.48 | $16.60 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $25.70 / $53.70
| Facility | | $10.96 | $25.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.98 / $36.31
| Professional | | $8.71 | $16.98 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.45 / $23.44
| Professional | | $12.59 | $14.45 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $33.88
| Professional | | $11.75 | $14.45 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $17.38
| Professional | | $8.71 | $8.71 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $44.67
| Facility | | $12.02 | $17.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $13.49 / $36.31
| Professional | | $8.71 | $13.49 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $24.55
| Professional | | $11.75 | $14.79 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $10.00 / $14.45
| Facility | | $6.61 | $10.00 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.71 / $30.90
| Professional | | $6.17 | $8.71 | $30.90 |