- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $32.36 / $97.72
| Facility | | $3.80 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $15.85 / $89.13
| Professional | | $7.94 | $15.85 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $33.88 / $77.62
| Facility | | $7.41 | $33.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $20.89 / $22.39
| Professional | | $14.79 | $20.89 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $32.36
| Professional | | $15.85 | $26.30 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $26.92 / $239.88
| Facility | | $4.90 | $26.92 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $8.13 / $13.49
| Professional | | $3.16 | $8.13 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $28.18
| Professional | | $16.60 | $16.60 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $436.52
| Facility | | $371.54 | $371.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.13 / $18.20
| Facility | | $5.75 | $8.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $8.13 / $12.30
| Professional | | $3.80 | $8.13 | $12.30 |