- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $38.90 / $109.65
| Facility | | $9.33 | $38.90 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.23 / $17.38
| Professional | | $8.51 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.94 / $21.88
| Professional | | $7.76 | $7.94 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $43.65
| Facility | | $25.12 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.13 / $10.47
| Professional | | $6.92 | $8.13 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $23.99 / $52.48
| Facility | | $7.94 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.13 / $17.78
| Professional | | $6.03 | $8.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $25.12 / $30.90
| Professional | | $9.55 | $25.12 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.47 / $22.39
| Facility | | $9.33 | $10.47 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $12.59 / $13.49
| Professional | | $9.33 | $12.59 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $11.48 / $20.42
| Facility | | $6.03 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.13 / $16.22
| Professional | | $5.75 | $8.13 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |