- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $95.50 / $275.42
| Facility | | $21.38 | $95.50 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.71 / $42.66
| Professional | | $7.08 | $8.71 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $26.30
| Facility | | $20.42 | $25.70 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $38.02
| Professional | | $4.68 | $4.68 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $10.00
| Facility | | $6.31 | $6.31 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $9.55
| Professional | | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $48.98
| Facility | | $26.30 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $30.20
| Professional | | $11.22 | $13.80 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $20.89 / $75.86
| Facility | | $8.51 | $20.89 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $104.71
| Facility | | $7.94 | $11.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.94 / $23.44
| Professional | | $5.62 | $7.94 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $32.36 / $64.57
| Professional | | $9.55 | $32.36 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $27.54
| Facility | | $11.48 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $15.85 / $26.92
| Professional | | $7.24 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $47.86
| Professional | | $12.88 | $24.55 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $67.61
| Facility | | $19.05 | $19.05 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.31 / $9.33
| Professional | | $5.13 | $6.31 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $52.48
| Professional | | $20.42 | $20.42 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $52.48
| Professional | | $33.88 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.51 / $11.48
| Facility | | $4.79 | $8.51 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $7.59 / $23.44
| Professional | | $3.98 | $7.59 | $23.44 |