- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $50.12 / $177.83
| Facility | | $10.00 | $50.12 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $16.60
| Professional | | $7.94 | $12.02 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $8.32 / $9.55
| Professional | | $6.61 | $8.32 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $43.65 / $75.86
| Facility | | $15.49 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.59 / $12.59
| Professional | | $5.01 | $7.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $18.62 / $25.12
| Facility | | $12.59 | $18.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.80 / $21.38
| Professional | | $9.55 | $13.80 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.80
| Facility | | $13.49 | $13.49 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $30.20 / $72.44
| Facility | | $15.85 | $30.20 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.00 / $22.91
| Professional | | $7.76 | $10.00 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $223.87
| Facility | | $83.18 | $83.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $74.13
| Facility | | $10.23 | $13.80 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.30 / $21.88
| Professional | | $7.94 | $12.30 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $11.48 / $11.48
| Professional | | $10.23 | $11.48 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $40.74
| Facility | | $10.23 | $13.80 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $22.91
| Professional | | $7.76 | $9.77 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $13.80 / $16.60
| Facility | | $5.75 | $13.80 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.94 / $12.02
| Professional | | $5.75 | $7.94 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $7.08 / $13.80
| Professional | | $5.37 | $7.08 | $13.80 |