- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $79.43 / $208.93
| Facility | | $8.91 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.62 / $34.67
| Professional | | $3.98 | $5.62 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $14.79 / $19.95
| Facility | | $9.12 | $14.79 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.31 / $10.23
| Professional | | $3.80 | $6.31 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.30 / $14.45
| Professional | | $11.75 | $12.30 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $6.61 / $120.23
| Facility | | $5.62 | $6.61 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.59 / $10.96
| Professional | | $5.62 | $7.59 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $11.22
| Facility | | $5.62 | $5.62 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $11.22
| Professional | | $5.62 | $5.62 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.13 / $16.60
| Facility | | $5.37 | $8.13 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $6.76 / $79.43
| Professional | | $5.50 | $6.76 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $16.98 / $22.91
| Facility | | $8.32 | $16.98 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.62 / $7.08
| Professional | | $4.17 | $5.62 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $6.76 / $8.91
| Facility | | $3.47 | $6.76 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.16 / $7.76
| Professional | | $2.34 | $3.16 | $7.76 |