- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $44.67 / $190.55
| Facility | | $13.18 | $44.67 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.80 / $19.05
| Professional | | $12.02 | $13.80 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.72 / $10.72
| Professional | | $10.23 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $66.07
| Facility | | $40.74 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.80 / $14.13
| Professional | | $11.48 | $13.80 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $32.36 / $70.79
| Facility | | $10.72 | $32.36 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.72 / $23.44
| Professional | | $7.94 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $44.67 / $52.48
| Professional | | $12.88 | $44.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $13.80 / $30.20
| Facility | | $12.30 | $13.80 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $13.80 / $15.49
| Professional | | $12.30 | $13.80 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $15.49 / $26.92
| Facility | | $7.76 | $15.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.72 / $21.38
| Professional | | $6.46 | $10.72 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |