- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $15.85 / $27.54
| Facility | | $5.50 | $15.85 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $10.00
| Professional | | $3.02 | $3.98 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Professional | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $5,011.87
| Facility | | $30.90 | $40.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $5.13
| Professional | | $4.57 | $4.57 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.91 / $19.95
| Facility | | $4.27 | $8.91 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $7.59 / $14.45
| Professional | | $3.39 | $7.59 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $8.51
| Professional | | $2.75 | $3.47 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Facility | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.61 / $10.23
| Professional | | $5.75 | $6.61 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $4.79
| Professional | | $3.89 | $3.89 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $15.49 / $20.89
| Facility | | $4.79 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $7.08
| Professional | | $3.98 | $3.98 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $7.24 / $114.82
| Facility | | $1.12 | $7.24 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $7.24 / $114.82
| Professional | | $1.12 | $7.24 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.89 / $7.08
| Facility | | $3.47 | $5.89 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.89 / $10.23
| Professional | | $2.63 | $3.89 | $10.23 |