- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $33.88 / $97.72
| Facility | | $12.88 | $33.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $21.88
| Professional | | $10.96 | $14.13 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $60.26 / $104.71
| Facility | | $23.44 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.00 / $17.78
| Professional | | $5.01 | $10.00 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $19.05
| Facility | | $18.20 | $18.20 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.02 / $97.72
| Facility | | $19.05 | $38.02 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $12.02 / $28.18
| Professional | | $9.77 | $12.02 | $28.18 |
- 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
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.20 / $54.95
| Facility | | $13.80 | $18.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.60 / $29.51
| Professional | | $10.96 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $15.49
| Professional | | $13.80 | $15.49 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.95 / $52.48
| Facility | | $13.80 | $19.95 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $12.02 / $27.54
| Professional | | $9.77 | $12.02 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $18.20 / $21.88
| Facility | | $7.76 | $18.20 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.55 / $16.98
| Professional | | $7.76 | $9.55 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $18.20
| Professional | | $7.08 | $9.55 | $18.20 |