- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $19.95 / $32.36
| Facility | | $6.92 | $19.95 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $12.88
| Professional | | $5.01 | $6.03 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $5,011.87
| Facility | | $38.90 | $51.29 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $7.24
| Professional | | $5.75 | $5.75 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $11.48 / $25.70
| Facility | | $5.37 | $11.48 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $9.77 / $17.38
| Professional | | $4.27 | $9.77 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.37 / $10.72
| Professional | | $3.47 | $4.37 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $7.41
| Facility | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.13 / $12.88
| Professional | | $7.41 | $8.13 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $19.50 / $25.12
| Facility | | $6.03 | $19.50 | $25.12 |
- 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
- $7.41 / $11.75 / $32.36
| Facility | | $7.41 | $11.75 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $11.75 / $26.30
| Professional | | $7.41 | $11.75 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $7.41 / $8.91
| Facility | | $4.37 | $7.41 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $5.50 / $12.88
| Professional | | $3.31 | $5.50 | $12.88 |