- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $117.49
| Facility | | $10.96 | $18.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $15.85
| Professional | | $8.91 | $10.96 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $50.12
| Facility | | $30.90 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $9.77 / $10.72
| Professional | | $8.32 | $9.77 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $28.84 / $63.10
| Facility | | $9.77 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $9.55 / $21.38
| Professional | | $7.24 | $9.55 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $28.84 / $30.20
| Professional | | $8.71 | $28.84 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $22.91
| Facility | | $11.22 | $15.14 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $38.02 / $42.66
| Professional | | $11.22 | $38.02 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $16.98 / $24.55
| Facility | | $7.41 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $24.55
| Professional | | $6.76 | $8.32 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $81.28
| Facility | | $67.61 | $67.61 | $81.28 |