- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $22.91 / $91.20
| Facility | | $14.79 | $22.91 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $17.38 / $43.65
| Professional | | $10.00 | $17.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $6.61
| Professional | | $6.61 | $6.61 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $45.71
| Facility | | $13.18 | $13.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $11.22 / $33.88
| Professional | | $6.46 | $11.22 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $29.51
| Facility | | $25.12 | $26.92 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $72.44
| Facility | | $17.38 | $24.55 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $12.59 / $33.88
| Professional | | $7.08 | $12.59 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $22.91 / $81.28
| Facility | | $11.75 | $22.91 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.94 / $15.85
| Professional | | $5.50 | $7.94 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $13.18 / $16.22
| Facility | | $5.89 | $13.18 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.94 / $15.85
| Professional | | $5.50 | $7.94 | $15.85 |