- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $19.05 / $63.10
| Facility | | $5.62 | $19.05 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $12.02
| Professional | | $5.01 | $5.01 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $5,011.87
| Facility | | $36.31 | $47.86 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.37 / $6.46
| Professional | | $5.37 | $5.37 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.47 / $23.44
| Facility | | $5.01 | $10.47 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $8.91 / $16.98
| Professional | | $3.98 | $8.91 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $6.92 / $10.00
| Professional | | $3.24 | $6.92 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $7.76 / $12.02
| Professional | | $6.76 | $7.76 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.75 / $57.54
| Facility | | $9.33 | $11.75 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $6.46
| Professional | | $4.17 | $4.17 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $10.72 / $19.95
| Facility | | $4.79 | $10.72 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $7.94
| Professional | | $5.01 | $5.01 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $11.48
| Facility | | $5.01 | $7.94 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $11.48
| Professional | | $5.01 | $7.94 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.92 / $8.32
| Facility | | $4.07 | $6.92 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $5.13 / $12.02
| Professional | | $3.09 | $5.13 | $12.02 |