- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $28.84 / $114.82
| Facility | | $5.62 | $28.84 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $35.48
| Professional | | $10.00 | $11.75 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $8.91
| Professional | | $7.76 | $7.76 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.88 / $15.14
| Facility | | $11.48 | $12.88 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $12.88 / $18.20
| Professional | | $10.72 | $12.88 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $33.11
| Facility | | $8.91 | $15.85 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $13.18 / $25.70
| Professional | | $6.46 | $13.18 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $54.95 / $123.03
| Facility | | $12.88 | $54.95 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $18.20
| Professional | | $7.76 | $7.76 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $6.46 / $8.91
| Professional | | $1.58 | $6.46 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.47 / $15.85
| Facility | | $5.37 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $18.20
| Professional | | $5.25 | $7.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $12.88
| Professional | | $8.91 | $8.91 | $12.88 |