- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $91.20 / $323.59
| Facility | | $13.80 | $91.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.13 / $50.12
| Professional | | $6.03 | $8.13 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.79 / $6.46
| Professional | | $3.72 | $4.79 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $18.62 / $40.74
| Facility | | $4.57 | $18.62 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $7.08 / $22.39
| Professional | | $3.98 | $7.08 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $58.88 / $120.23
| Facility | | $18.62 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $9.12 / $26.30
| Professional | | $6.46 | $9.12 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $14.13 / $33.88
| Facility | | $6.17 | $14.13 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $9.55 / $18.62
| Professional | | $5.25 | $9.55 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $8.13 / $12.88
| Professional | | $5.62 | $8.13 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.13 / $18.20
| Professional | | $6.46 | $8.13 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.72 / $19.95
| Professional | | $6.92 | $10.72 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $9.77
| Professional | | $4.79 | $4.79 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.77 / $24.55
| Facility | | $6.76 | $9.77 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.13 / $18.62
| Professional | | $4.79 | $8.13 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.32 / $13.80
| Professional | | $6.46 | $8.32 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $5.50 / $8.13
| Facility | | $3.39 | $5.50 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $5.25 / $30.20
| Professional | | $3.39 | $5.25 | $30.20 |