- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $36.31 / $147.91
| Facility | | $10.47 | $36.31 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.08 / $28.84
| Professional | | $6.03 | $7.08 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $21.38 / $28.84
| Facility | | $13.18 | $21.38 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $9.12 / $15.14
| Professional | | $5.50 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $17.78 / $20.42
| Professional | | $16.60 | $17.78 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $64.57
| Facility | | $8.13 | $8.13 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.72 / $16.22
| Professional | | $8.13 | $10.72 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $16.22
| Facility | | $8.13 | $8.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $15.14
| Professional | | $8.13 | $8.13 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $11.75 / $23.99
| Facility | | $7.76 | $11.75 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $9.77 / $79.43
| Professional | | $8.13 | $9.77 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $23.99 / $33.11
| Facility | | $12.02 | $23.99 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.32 / $10.23
| Professional | | $6.03 | $8.32 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.77 / $12.88
| Facility | | $5.13 | $9.77 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.57 / $11.22
| Professional | | $3.39 | $4.57 | $11.22 |