- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $77.62 / $263.03
| Facility | | $6.03 | $77.62 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $10.00
| Professional | | $3.98 | $5.01 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $5.62 / $5.62
| Professional | | $3.39 | $5.62 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.62 / $7.59
| Facility | | $4.47 | $5.62 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.62 / $7.94
| Professional | | $4.68 | $5.62 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $6.76 / $14.45
| Facility | | $3.89 | $6.76 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.75 / $10.96
| Professional | | $2.95 | $5.75 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $52.48
| Facility | | $14.45 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $7.76
| Professional | | $3.39 | $3.39 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $3.39
| Professional | | $2.69 | $2.69 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.17 / $6.76
| Facility | | $2.34 | $4.17 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.24 / $7.76
| Professional | | $2.34 | $3.24 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $5.62
| Professional | | $3.39 | $3.39 | $5.62 |