- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $38.02 / $104.71
| Facility | | $14.79 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.49 / $23.99
| Professional | | $12.02 | $15.49 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $120.23
| Facility | | $25.12 | $67.61 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.22 / $19.50
| Professional | | $5.01 | $11.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.89 / $32.36
| Professional | | $14.13 | $20.89 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $20.42
| Facility | | $19.50 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $107.15
| Facility | | $23.44 | $44.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $33.88
| Professional | | $11.48 | $14.79 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $234.42
| Facility | | $117.49 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $63.10
| Facility | | $15.14 | $20.42 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $32.36
| Professional | | $12.02 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $16.98
| Professional | | $15.14 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $21.88 / $58.88
| Facility | | $16.22 | $21.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $33.88
| Professional | | $11.48 | $14.79 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.42 / $23.99
| Facility | | $9.12 | $20.42 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $11.75 / $19.95
| Professional | | $8.51 | $11.75 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $20.42
| Professional | | $7.94 | $10.47 | $20.42 |