- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $38.02 / $120.23
| Facility | | $6.92 | $38.02 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $10.00
| Professional | | $5.01 | $6.03 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.07 / $6.92
| Professional | | $3.47 | $4.07 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.92 / $8.13
| Facility | | $6.03 | $6.92 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.92 / $10.00
| Professional | | $5.75 | $6.92 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.32 / $17.78
| Facility | | $4.79 | $8.32 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $7.08 / $13.49
| Professional | | $3.63 | $7.08 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $29.51 / $64.57
| Facility | | $6.92 | $29.51 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $9.55
| Professional | | $4.07 | $4.07 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $4.17
| Professional | | $3.31 | $3.31 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.62 / $8.51
| Facility | | $2.88 | $5.62 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.07 / $9.55
| Professional | | $2.88 | $4.07 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $6.92
| Professional | | $4.17 | $4.17 | $6.92 |