- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $15.14 / $25.70
| Facility | | $5.50 | $15.14 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $10.00
| Professional | | $3.02 | $3.98 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $5,011.87
| Facility | | $22.91 | $30.20 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $4.57
| Professional | | $4.57 | $4.57 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $8.51 / $19.95
| Facility | | $3.98 | $8.51 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $6.46 / $10.72
| Professional | | $2.63 | $6.46 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.79 / $8.51
| Professional | | $2.75 | $4.79 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $5.75
| Facility | | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.62 / $10.00
| Professional | | $4.47 | $5.62 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $11.22 / $19.95
| Facility | | $3.98 | $11.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.03
| Professional | | $3.02 | $3.98 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.24 / $7.24
| Facility | | $5.75 | $7.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.24 / $7.24
| Professional | | $5.13 | $7.24 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.75 / $6.92
| Facility | | $2.88 | $5.75 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.63 / $8.71
| Professional | | $2.45 | $3.63 | $8.71 |