- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $56.23 / $107.15
| Facility | | $9.12 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $11.75
| Professional | | $5.01 | $6.03 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.68 / $12.30
| Professional | | $4.07 | $4.68 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $13.49
| Facility | | $7.08 | $10.00 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $6.76
| Professional | | $5.01 | $6.03 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $14.79 / $23.99
| Facility | | $6.92 | $14.79 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.92 / $10.72
| Professional | | $4.07 | $6.92 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.89 / $7.08
| Professional | | $4.27 | $5.89 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $13.49
| Facility | | $6.76 | $6.76 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $13.49
| Professional | | $6.76 | $6.76 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $11.75 / $18.62
| Facility | | $6.76 | $11.75 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $7.94
| Professional | | $6.03 | $6.03 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.00 / $17.78
| Facility | | $7.76 | $10.00 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $6.76
| Professional | | $5.01 | $6.03 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $7.94
| Facility | | $6.03 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.89 / $9.33
| Professional | | $2.82 | $3.89 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.47 / $12.02
| Professional | | $3.02 | $3.47 | $12.02 |