- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $25.12 / $107.15
| Facility | | $5.62 | $25.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.80 / $26.30
| Professional | | $12.02 | $13.80 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $10.72
| Professional | | $9.12 | $9.12 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $15.14 / $17.78
| Facility | | $13.49 | $15.14 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $21.38
| Professional | | $12.59 | $15.14 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $18.62 / $38.90
| Facility | | $10.72 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $15.85 / $30.20
| Professional | | $7.76 | $15.85 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $66.07 / $144.54
| Facility | | $15.14 | $66.07 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $21.38
| Professional | | $9.12 | $9.12 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $7.41 / $10.47
| Professional | | $1.86 | $7.41 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $12.59 / $19.05
| Facility | | $6.46 | $12.59 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.91 / $21.38
| Professional | | $5.37 | $8.91 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $15.14
| Professional | | $10.47 | $10.47 | $15.14 |