- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $54.95 / $112.20
| Facility | | $5.13 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.79 / $7.08
| Professional | | $3.02 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.72 / $16.98
| Professional | | $3.24 | $3.72 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $19.95
| Facility | | $11.75 | $16.60 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.80 / $4.90
| Professional | | $3.24 | $3.80 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $11.48 / $24.55
| Facility | | $3.72 | $11.48 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.80 / $8.32
| Professional | | $2.82 | $3.80 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $10.47 / $14.45
| Professional | | $4.47 | $10.47 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.90 / $10.47
| Facility | | $4.27 | $4.90 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $6.03 / $6.76
| Professional | | $4.37 | $6.03 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31,622.78 / $31,622.78 / $43,651.58
| Facility | | $31,622.78 | $31,622.78 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $7.08 / $45.71
| Facility | | $2.82 | $7.08 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.72 / $7.59
| Professional | | $2.69 | $3.72 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |