- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $36.31 / $102.33
| Facility | | $14.13 | $36.31 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $23.44
| Professional | | $12.02 | $15.85 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $117.49
| Facility | | $26.30 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.72 / $19.50
| Professional | | $5.01 | $10.72 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $22.39
| Facility | | $19.50 | $19.50 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $104.71
| Facility | | $22.91 | $42.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $33.11
| Professional | | $10.96 | $14.13 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $95.50 / $239.88
| Facility | | $93.33 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $19.50 / $52.48
| Facility | | $14.79 | $19.50 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $19.50 / $35.48
| Professional | | $10.96 | $19.50 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $16.60
| Professional | | $14.79 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $21.38 / $57.54
| Facility | | $15.49 | $21.38 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $32.36
| Professional | | $10.96 | $14.13 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.50 / $23.44
| Facility | | $8.71 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $19.50
| Professional | | $8.13 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.23 / $19.50
| Professional | | $7.59 | $10.23 | $19.50 |