- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $91.20
| Facility | | $6.03 | $10.00 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $8.91
| Professional | | $5.01 | $6.03 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $27.54
| Facility | | $17.78 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.75 / $5.75
| Professional | | $4.79 | $5.75 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $16.98 / $37.15
| Facility | | $5.50 | $16.98 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.79 / $11.22
| Professional | | $3.72 | $4.79 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $15.85
| Professional | | $5.62 | $5.62 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.03 / $12.59
| Facility | | $4.79 | $6.03 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.91 / $10.00
| Professional | | $5.37 | $8.91 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $8.13 / $11.75
| Facility | | $4.07 | $8.13 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.57 / $9.33
| Professional | | $3.72 | $4.57 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |