- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $30.90 / $117.49
| Facility | | $7.59 | $30.90 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $7.08 / $20.42
| Professional | | $4.47 | $7.08 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $5.37
| Professional | | $4.68 | $4.68 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $15.49
| Facility | | $8.13 | $11.48 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.92 / $7.76
| Professional | | $5.75 | $6.92 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $16.98 / $26.92
| Facility | | $7.94 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $8.32 / $12.30
| Professional | | $4.68 | $8.32 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.76 / $64.57
| Professional | | $4.90 | $6.76 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $15.49
| Facility | | $7.76 | $7.76 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $9.33
| Professional | | $7.76 | $7.76 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $13.49 / $21.38
| Facility | | $7.76 | $13.49 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $9.33
| Professional | | $6.92 | $6.92 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $11.48 / $20.42
| Facility | | $8.91 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.92 / $7.76
| Professional | | $5.75 | $6.92 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.33 / $9.33
| Facility | | $6.92 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.47 / $9.77
| Professional | | $3.24 | $4.47 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.98 / $13.80
| Professional | | $3.47 | $3.98 | $13.80 |