- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $24.55 / $63.10
| Facility | | $10.23 | $24.55 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.24 / $12.30
| Professional | | $6.03 | $7.24 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $21.38 / $29.51
| Facility | | $13.18 | $21.38 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $9.12 / $15.14
| Professional | | $5.62 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.20 / $21.38
| Professional | | $16.98 | $18.20 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $27.54
| Facility | | $8.13 | $8.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $14.79
| Professional | | $8.13 | $10.23 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $16.60
| Facility | | $8.13 | $8.13 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $9.77
| Professional | | $8.13 | $8.13 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $24.55
| Facility | | $7.94 | $11.75 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $9.77 / $79.43
| Professional | | $8.13 | $9.77 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $24.55 / $33.88
| Facility | | $12.30 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $10.47
| Professional | | $6.17 | $8.32 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.77 / $13.18
| Facility | | $5.13 | $9.77 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.68 / $11.48
| Professional | | $3.47 | $4.68 | $11.48 |