- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $45.71 / $95.50
| Facility | | $6.17 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.25 / $16.60
| Professional | | $4.27 | $5.25 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $3.98 / $12.88
| Professional | | $1.58 | $3.98 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $24.55
| Facility | | $12.88 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $5.25
| Professional | | $4.37 | $4.37 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $12.02 / $26.30
| Facility | | $3.98 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.07 / $8.91
| Professional | | $3.02 | $4.07 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $10.72 / $25.70
| Professional | | $4.79 | $10.72 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.57 / $11.22
| Facility | | $4.47 | $4.57 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $26.92 / $30.20
| Professional | | $4.68 | $26.92 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $131.83
| Facility | | $60.26 | $60.26 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.59 / $10.00
| Facility | | $3.02 | $7.59 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.07 / $8.32
| Professional | | $2.88 | $4.07 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |