- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $53.70 / $147.91
| Facility | | $14.13 | $53.70 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.18 / $16.98
| Professional | | $9.55 | $13.18 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.23 / $10.23
| Professional | | $9.12 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $29.51
| Facility | | $15.49 | $21.88 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $14.79
| Professional | | $10.96 | $13.18 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $31.62 / $47.86
| Facility | | $15.49 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $15.49 / $23.44
| Professional | | $9.12 | $15.49 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.88 / $64.57
| Professional | | $9.55 | $12.88 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $29.51
| Facility | | $14.79 | $14.79 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.22 / $29.51
| Professional | | $14.79 | $16.22 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $25.70 / $40.74
| Facility | | $14.79 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $17.78
| Professional | | $13.18 | $13.18 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $38.90
| Facility | | $16.98 | $22.39 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $14.79
| Professional | | $10.96 | $13.18 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.78 / $17.78
| Facility | | $13.18 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.71 / $18.62
| Professional | | $6.17 | $8.71 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $7.59 / $26.30
| Professional | | $6.61 | $7.59 | $26.30 |