- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $53.70 / $186.21
| Facility | | $18.20 | $53.70 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $34.67
| Professional | | $8.91 | $14.13 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $5,011.87
| Facility | | $66.07 | $89.13 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $14.13
| Professional | | $9.33 | $9.33 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $18.62 / $41.69
| Facility | | $11.75 | $18.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $11.22 / $18.20
| Professional | | $5.50 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $17.38
| Professional | | $5.62 | $7.08 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $20.89
| Professional | | $10.23 | $13.80 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.20 / $53.70
| Facility | | $16.22 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $9.12 / $12.88
| Professional | | $7.24 | $9.12 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.30 / $46.77
| Facility | | $8.51 | $26.30 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $21.88
| Professional | | $8.91 | $14.13 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.02 / $20.42
| Facility | | $8.71 | $12.02 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $14.45
| Professional | | $8.71 | $10.72 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $12.02 / $14.45
| Facility | | $7.24 | $12.02 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $10.96 / $21.88
| Professional | | $7.24 | $10.96 | $21.88 |