- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $52.48 / $85.11
| Facility | | $16.60 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $15.85 / $37.15
| Professional | | $3.98 | $15.85 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $5,011.87
| Facility | | $23.99 | $31.62 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Professional | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $27.54 / $60.26
| Facility | | $9.33 | $27.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $9.55 / $30.20
| Professional | | $2.82 | $9.55 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $9.55 / $29.51
| Professional | | $4.47 | $9.55 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $14.13 / $35.48
| Professional | | $4.79 | $14.13 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $69.18
| Facility | | $12.02 | $16.98 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $15.85 / $22.91
| Professional | | $3.98 | $15.85 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $7.76 / $20.42
| Facility | | $2.88 | $7.76 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $14.13 / $20.42
| Professional | | $2.88 | $14.13 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $20.42 / $24.55
| Facility | | $3.16 | $20.42 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $9.12 / $24.55
| Professional | | $3.72 | $9.12 | $24.55 |