- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $72.44
| Facility | | $10.00 | $26.30 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $16.98
| Professional | | $7.94 | $10.96 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $45.71 / $83.18
| Facility | | $17.38 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.76 / $13.49
| Professional | | $5.01 | $7.76 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $14.13
| Facility | | $10.72 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $74.13
| Facility | | $16.22 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $23.44
| Professional | | $7.94 | $10.23 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $42.66
| Facility | | $10.72 | $14.13 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $20.89
| Professional | | $7.94 | $12.59 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $11.75 / $11.75
| Professional | | $10.47 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.13 / $41.69
| Facility | | $11.22 | $14.13 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $23.44
| Professional | | $7.94 | $10.23 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $14.13 / $16.98
| Facility | | $6.31 | $14.13 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.32 / $13.80
| Professional | | $5.89 | $8.32 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.24 / $14.13
| Professional | | $5.50 | $7.24 | $14.13 |