- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $50.12 / $104.71
| Facility | | $16.98 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.91 / $64.57
| Professional | | $6.17 | $8.91 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $22.91 / $48.98
| Facility | | $5.01 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $7.76 / $25.70
| Professional | | $4.27 | $7.76 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $63.10 / $138.04
| Facility | | $21.88 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.00 / $28.18
| Professional | | $6.92 | $10.00 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $17.38 / $35.48
| Facility | | $7.41 | $17.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $11.22 / $21.88
| Professional | | $5.75 | $11.22 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $15.49
| Professional | | $7.76 | $9.77 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $22.39
| Professional | | $7.76 | $9.77 | $22.39 |
- 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
- $4.90 / $4.90 / $9.77
| Professional | | $4.90 | $4.90 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $11.75 / $28.84
| Facility | | $5.13 | $11.75 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.23 / $21.88
| Professional | | $5.75 | $10.23 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.00 / $16.60
| Professional | | $7.76 | $10.00 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $6.46 / $9.77
| Facility | | $4.37 | $6.46 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.25 / $18.62
| Professional | | $4.07 | $5.25 | $18.62 |