- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $24.55 / $67.61
| Facility | | $10.00 | $24.55 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $15.85
| Professional | | $7.08 | $10.00 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $41.69 / $72.44
| Facility | | $17.38 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.24 / $12.02
| Professional | | $5.01 | $7.24 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $13.18 / $13.18
| Facility | | $9.33 | $13.18 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $28.84 / $70.79
| Facility | | $15.49 | $28.84 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $22.39
| Professional | | $7.59 | $9.55 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $114.82
| Facility | | $102.33 | $102.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $38.02
| Facility | | $10.00 | $13.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $12.59 / $19.95
| Professional | | $7.08 | $12.59 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $33.11
| Professional | | $10.00 | $10.96 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.13 / $38.90
| Facility | | $10.23 | $14.13 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $21.88
| Professional | | $7.59 | $9.55 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $13.18 / $15.85
| Facility | | $5.50 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.59 / $12.59
| Professional | | $5.50 | $7.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.76 / $13.18
| Professional | | $5.13 | $6.76 | $13.18 |