- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $70.79 / $95.50
| Facility | | $14.45 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $18.62 / $39.81
| Professional | | $3.98 | $18.62 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $9.12
| Professional | | $7.76 | $7.76 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $77.62
| Facility | | $30.20 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $10.00
| Professional | | $6.61 | $9.55 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $11.75 / $14.79
| Professional | | $6.92 | $11.75 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $10.96 / $128.82
| Facility | | $3.72 | $10.96 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.72 / $6.76
| Professional | | $2.57 | $3.72 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $12.59
| Professional | | $6.92 | $6.92 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.72 / $7.59
| Facility | | $2.57 | $3.72 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.72 / $6.76
| Professional | | $3.47 | $3.72 | $6.76 |