- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $47.86 / $95.50
| Facility | | $14.79 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $61.66
| Professional | | $7.08 | $8.91 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $25.12 / $53.70
| Facility | | $5.01 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.13 / $27.54
| Professional | | $4.27 | $8.13 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $60.26 / $131.83
| Facility | | $21.88 | $60.26 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $9.33 / $28.84
| Professional | | $6.61 | $9.33 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $19.05 / $36.31
| Facility | | $7.59 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.72 / $21.88
| Professional | | $5.75 | $10.72 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.72 / $17.38
| Professional | | $8.51 | $10.72 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.72 / $24.55
| Professional | | $8.51 | $10.72 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $12.88
| Professional | | $6.46 | $6.46 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.30 / $28.18
| Facility | | $7.76 | $12.30 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $21.88
| Professional | | $5.75 | $8.32 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.96 / $18.20
| Professional | | $8.51 | $10.96 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.46 / $10.72
| Facility | | $4.79 | $6.46 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.46 / $20.42
| Professional | | $4.47 | $6.46 | $20.42 |