- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $41.69 / $89.13
| Facility | | $13.80 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $52.48
| Professional | | $5.01 | $7.08 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $4.68
| Professional | | $4.68 | $4.68 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $18.20 / $39.81
| Facility | | $4.47 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $6.92 / $26.30
| Professional | | $3.89 | $6.92 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $57.54 / $125.89
| Facility | | $18.20 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $8.91 / $25.70
| Professional | | $6.31 | $8.91 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $13.80 / $28.84
| Facility | | $6.03 | $13.80 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $9.12 / $19.95
| Professional | | $4.68 | $9.12 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $12.59
| Professional | | $7.08 | $7.94 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.94 / $17.78
| Professional | | $6.31 | $7.94 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $9.33
| Professional | | $4.68 | $4.68 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $24.55
| Facility | | $6.46 | $9.33 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $7.24 / $19.95
| Professional | | $4.68 | $7.24 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.94 / $13.49
| Professional | | $6.31 | $7.94 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $5.37 / $7.94
| Facility | | $3.55 | $5.37 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.79 / $16.22
| Professional | | $3.31 | $4.79 | $16.22 |