- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $93.33 / $186.21
| Facility | | $32.36 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $120.23
| Professional | | $12.02 | $16.98 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $42.66 / $91.20
| Facility | | $9.33 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $14.45 / $45.71
| Professional | | $8.13 | $14.45 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $97.72 / $263.03
| Facility | | $39.81 | $97.72 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $18.62 / $54.95
| Professional | | $13.18 | $18.62 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $66.07
| Facility | | $13.80 | $32.36 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $19.95 / $41.69
| Professional | | $9.77 | $19.95 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $18.20 / $29.51
| Professional | | $14.79 | $18.20 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $18.20 / $41.69
| Professional | | $14.79 | $18.20 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $21.88
| Professional | | $10.96 | $10.96 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $47.86
| Facility | | $14.79 | $21.38 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $16.60 / $41.69
| Professional | | $9.77 | $16.60 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $18.62 / $30.90
| Professional | | $14.79 | $18.62 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $12.02 / $18.20
| Facility | | $8.32 | $12.02 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $35.48
| Professional | | $7.76 | $10.96 | $35.48 |