- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $36.31 / $186.21
| Facility | | $9.55 | $36.31 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $15.85
| Professional | | $7.94 | $10.00 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $8.32
| Professional | | $7.08 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $52.48
| Facility | | $26.30 | $37.15 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.32 / $10.72
| Professional | | $5.37 | $8.32 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $53.70
| Facility | | $8.32 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $18.20
| Professional | | $6.17 | $8.32 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $23.44 / $34.67
| Professional | | $10.00 | $23.44 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $10.72 / $23.44
| Facility | | $9.55 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.30 / $13.80
| Professional | | $9.55 | $12.30 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $12.02 / $20.89
| Facility | | $6.31 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.32 / $16.60
| Professional | | $6.03 | $8.32 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |