- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $60.26 / $123.03
| Facility | | $11.75 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $40.74
| Professional | | $7.08 | $10.96 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $9.77
| Professional | | $8.32 | $8.32 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $15.14
| Facility | | $10.96 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $16.22
| Professional | | $10.96 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Facility | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $9.77
| Professional | | $6.31 | $6.31 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $12.88 / $25.70
| Facility | | $7.76 | $12.88 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.96 / $15.14
| Professional | | $5.75 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $11.22 / $23.44
| Professional | | $9.55 | $11.22 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $11.22
| Facility | | $6.31 | $9.77 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.76 / $16.22
| Professional | | $4.07 | $6.76 | $16.22 |