- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $39.81
| Facility | | $8.91 | $12.59 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $19.05
| Professional | | $7.94 | $8.91 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $38.02
| Facility | | $26.92 | $33.11 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $10.23 / $15.85
| Professional | | $7.41 | $10.23 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $54.95
| Facility | | $10.00 | $26.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $8.32 / $19.50
| Professional | | $5.62 | $8.32 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Professional | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.79 / $27.54
| Facility | | $9.77 | $14.79 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Professional | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.88
| Professional | | $12.02 | $12.02 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.13 / $17.78
| Facility | | $8.71 | $14.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $20.42
| Professional | | $6.76 | $8.51 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $245.47
| Facility | | $194.98 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |