- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $26.92 / $109.65
| Facility | | $12.88 | $26.92 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $14.45 / $35.48
| Professional | | $3.02 | $14.45 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $70.79
| Facility | | $28.18 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $8.91
| Professional | | $5.75 | $8.32 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $10.23 / $12.88
| Professional | | $6.17 | $10.23 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $16.60 / $107.15
| Facility | | $3.55 | $16.60 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.24 / $10.00
| Professional | | $2.45 | $3.24 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $11.22
| Professional | | $6.61 | $6.61 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $6.61
| Facility | | $6.61 | $6.61 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $141.25
| Facility | | $120.23 | $120.23 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.24 / $7.24
| Facility | | $2.24 | $3.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.24 / $5.89
| Professional | | $3.09 | $3.24 | $5.89 |