- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $40.74 / $141.25
| Facility | | $14.13 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.30 / $34.67
| Professional | | $10.00 | $12.30 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $9.12 / $21.38
| Professional | | $5.50 | $9.12 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.45 / $25.12
| Facility | | $12.59 | $14.45 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $17.38
| Professional | | $6.76 | $8.32 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $17.38
| Facility | | $10.96 | $14.45 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $13.80 / $18.62
| Professional | | $8.91 | $13.80 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $17.78 / $56.23
| Facility | | $9.12 | $17.78 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.91 / $25.70
| Professional | | $6.92 | $8.91 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $35.48 / $141.25
| Facility | | $10.00 | $35.48 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.72 / $23.44
| Professional | | $5.50 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.30 / $16.98
| Professional | | $10.23 | $12.30 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $28.18
| Professional | | $9.55 | $14.45 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $13.80 / $20.42
| Facility | | $6.31 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $19.05
| Professional | | $5.75 | $8.32 | $19.05 |