- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $50.12 / $97.72
| Facility | | $19.50 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $20.89 / $70.79
| Professional | | $8.91 | $20.89 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $63.10 / $134.90
| Facility | | $12.59 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $12.59 / $38.02
| Professional | | $6.76 | $12.59 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $69.18 / $138.04
| Facility | | $23.44 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.77 / $37.15
| Professional | | $6.92 | $9.77 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $47.86 / $91.20
| Facility | | $10.96 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $15.49 / $47.86
| Professional | | $6.46 | $15.49 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $26.92 / $43.65
| Professional | | $9.33 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $58.88
| Professional | | $21.88 | $26.92 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $32.36
| Professional | | $16.22 | $16.22 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $24.55 / $69.18
| Facility | | $13.49 | $24.55 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $14.45 / $51.29
| Professional | | $6.46 | $14.45 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $21.88 / $27.54
| Professional | | $16.22 | $21.88 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $16.22 / $26.92
| Facility | | $6.31 | $16.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.48 / $51.29
| Professional | | $5.01 | $11.48 | $51.29 |