- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $338.84
| Facility | | $7.94 | $12.59 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $10.96
| Professional | | $6.03 | $7.94 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $34.67
| Facility | | $22.91 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.61 / $7.24
| Professional | | $6.17 | $6.61 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $21.38 / $46.77
| Facility | | $7.08 | $21.38 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $5.75 / $14.13
| Professional | | $4.90 | $5.75 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $19.50 / $107.15
| Professional | | $6.61 | $19.50 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $7.59 / $15.49
| Facility | | $6.61 | $7.59 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $22.39 / $25.12
| Professional | | $6.76 | $22.39 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $10.47 / $13.80
| Facility | | $4.37 | $10.47 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.75 / $11.48
| Professional | | $4.37 | $5.75 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $107.15
| Facility | | $70.79 | $70.79 | $107.15 |