- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $77.62 / $416.87
| Facility | | $11.48 | $77.62 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.08 / $74.13
| Professional | | $6.03 | $7.08 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.25 / $6.03
| Professional | | $4.37 | $5.25 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.71 / $10.23
| Facility | | $7.76 | $8.71 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $8.71 / $12.59
| Professional | | $7.24 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $9.77 / $22.39
| Facility | | $6.03 | $9.77 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $9.33 / $16.60
| Professional | | $4.68 | $9.33 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $8.91
| Facility | | $6.03 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $12.02 / $17.38
| Professional | | $3.98 | $12.02 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $4.17 / $5.25
| Professional | | $1.05 | $4.17 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $7.08 / $10.72
| Facility | | $3.63 | $7.08 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.13 / $12.02
| Professional | | $3.16 | $5.13 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $5.25
| Professional | | $5.25 | $5.25 | $5.25 |