- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $64.57 / $257.04
| Facility | | $15.14 | $64.57 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $26.92
| Professional | | $12.88 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $12.02
| Professional | | $10.72 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $17.78 / $20.89
| Facility | | $15.85 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $25.12
| Professional | | $14.79 | $17.78 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.88 / $45.71
| Facility | | $12.59 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $18.62 / $35.48
| Professional | | $9.12 | $18.62 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $77.62 / $169.82
| Facility | | $17.78 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $25.12
| Professional | | $10.72 | $10.72 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $8.51 / $10.72
| Professional | | $2.14 | $8.51 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $16.22 / $22.39
| Facility | | $7.59 | $16.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.47 / $25.12
| Professional | | $7.59 | $10.47 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $17.78
| Professional | | $10.72 | $10.72 | $17.78 |