- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $66.07 / $141.25
| Facility | | $26.30 | $66.07 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $67.61
| Professional | | $8.91 | $10.96 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $29.51 / $63.10
| Facility | | $7.24 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $10.96 / $40.74
| Professional | | $6.17 | $10.96 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $85.11 / $199.53
| Facility | | $28.84 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $40.74
| Professional | | $10.00 | $14.45 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $21.88 / $45.71
| Facility | | $9.55 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $14.45 / $31.62
| Professional | | $7.59 | $14.45 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $12.59 / $19.95
| Professional | | $11.22 | $12.59 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $28.84
| Professional | | $10.00 | $12.59 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $97.72
| Facility | | $77.62 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $12.59
| Professional | | $6.31 | $6.31 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $38.02
| Facility | | $10.47 | $15.14 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $11.48 / $31.62
| Professional | | $7.59 | $11.48 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $21.38
| Professional | | $10.00 | $12.88 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $8.71 / $12.59
| Facility | | $5.62 | $8.71 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $25.70
| Professional | | $5.25 | $7.59 | $25.70 |