- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $27.54 / $89.13
| Facility | | $10.96 | $27.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $17.78
| Professional | | $8.91 | $10.96 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $50.12 / $89.13
| Facility | | $19.50 | $50.12 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $8.13 / $14.13
| Professional | | $5.01 | $8.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $16.98
| Facility | | $14.79 | $14.79 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $77.62
| Facility | | $16.98 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.72 / $24.55
| Professional | | $8.32 | $10.72 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $85.11
| Facility | | $70.79 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $67.61
| Facility | | $11.22 | $14.79 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $14.13 / $26.30
| Professional | | $7.94 | $14.13 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.30 / $33.11
| Professional | | $10.96 | $12.30 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $42.66
| Facility | | $11.75 | $14.79 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.72 / $24.55
| Professional | | $8.32 | $10.72 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $14.79 / $17.78
| Facility | | $6.17 | $14.79 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.51 / $14.45
| Professional | | $6.17 | $8.51 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.59 / $14.79
| Professional | | $5.75 | $7.59 | $14.79 |