- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $43.65 / $87.10
| Facility | | $13.80 | $43.65 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $43.65
| Professional | | $6.03 | $8.91 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $23.44 / $50.12
| Facility | | $4.68 | $23.44 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $7.41 / $38.02
| Professional | | $4.07 | $7.41 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $57.54 / $123.03
| Facility | | $20.42 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.71 / $26.92
| Professional | | $6.17 | $8.71 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $17.78 / $33.88
| Facility | | $7.08 | $17.78 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.00 / $20.89
| Professional | | $5.37 | $10.00 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $16.22
| Professional | | $8.13 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $23.44
| Professional | | $8.13 | $10.00 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $12.02
| Professional | | $6.03 | $6.03 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $11.75 / $26.30
| Facility | | $7.41 | $11.75 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $7.76 / $20.89
| Professional | | $5.37 | $7.76 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $16.98
| Professional | | $8.13 | $10.23 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.03 / $10.00
| Facility | | $4.57 | $6.03 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.68 / $19.05
| Professional | | $4.27 | $4.68 | $19.05 |