- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $61.66 / $229.09
| Facility | | $9.55 | $61.66 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $8.91 / $18.62
| Professional | | $3.31 | $8.91 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $6.17 / $6.17
| Professional | | $5.89 | $6.17 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $295.12
| Facility | | $95.50 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.71 / $9.77
| Professional | | $7.41 | $8.71 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $21.88 / $45.71
| Facility | | $10.23 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $10.47 / $15.49
| Professional | | $4.90 | $10.47 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.33 / $25.12
| Professional | | $7.59 | $9.33 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $19.50
| Facility | | $9.77 | $9.77 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $10.72
| Professional | | $9.77 | $9.77 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $15.49 / $33.11
| Facility | | $8.71 | $15.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $11.75
| Professional | | $8.71 | $8.71 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $144.54 / $295.12
| Facility | | $52.48 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.71 / $9.77
| Professional | | $7.41 | $8.71 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $177.83 / $295.12
| Facility | | $9.77 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.31 / $16.22
| Professional | | $4.07 | $6.31 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.01 / $17.78
| Professional | | $4.37 | $5.01 | $17.78 |