- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $245.47 / $275.42
| Facility | | $9.55 | $245.47 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $14.13
| Professional | | $7.94 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.59 / $7.59
| Professional | | $6.46 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $38.02
| Facility | | $26.92 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $8.51
| Professional | | $7.24 | $7.24 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $25.70 / $54.95
| Facility | | $9.12 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $13.49 / $18.62
| Professional | | $6.76 | $13.49 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $10.47 / $12.02
| Facility | | $6.31 | $10.47 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.12 / $10.72
| Professional | | $7.76 | $9.12 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $12.02 / $14.45
| Facility | | $6.03 | $12.02 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $6.03 / $12.30
| Professional | | $5.37 | $6.03 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |