- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $91.20 / $223.87
| Facility | | $10.96 | $91.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.48 / $23.44
| Professional | | $9.33 | $11.48 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $54.95
| Facility | | $35.48 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.75 / $26.92
| Professional | | $7.76 | $11.75 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $26.92 / $58.88
| Facility | | $8.91 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.91 / $19.95
| Professional | | $6.76 | $8.91 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $28.18 / $43.65
| Professional | | $9.33 | $28.18 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $25.12
| Facility | | $10.23 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $19.05 / $20.89
| Professional | | $10.23 | $19.05 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $12.88 / $22.39
| Facility | | $6.46 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.91 / $18.20
| Professional | | $5.37 | $8.91 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |