- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $69.18 / $239.88
| Facility | | $18.62 | $69.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $61.66
| Professional | | $7.08 | $9.77 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $6.03 / $15.49
| Professional | | $5.89 | $6.03 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $22.91 / $48.98
| Facility | | $4.90 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $7.41 / $28.84
| Professional | | $4.17 | $7.41 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $61.66 / $134.90
| Facility | | $21.38 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.77 / $27.54
| Professional | | $6.76 | $9.77 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $16.98 / $35.48
| Facility | | $7.41 | $16.98 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $10.47 / $21.38
| Professional | | $5.25 | $10.47 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.77 / $15.49
| Professional | | $7.59 | $9.77 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $22.39
| Professional | | $7.76 | $9.77 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $11.75
| Professional | | $5.89 | $5.89 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $25.12
| Facility | | $7.76 | $11.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $8.51 / $21.38
| Professional | | $5.25 | $8.51 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.00 / $16.60
| Professional | | $7.76 | $10.00 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $6.31 / $9.77
| Facility | | $4.37 | $6.31 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.25 / $20.89
| Professional | | $4.07 | $5.25 | $20.89 |