- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $30.90 / $208.93
| Facility | | $6.17 | $30.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $34.67
| Professional | | $3.98 | $5.01 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $3.80
| Professional | | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.32 / $11.22
| Facility | | $5.89 | $8.32 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.01 / $5.62
| Professional | | $4.17 | $5.01 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $12.30 / $19.95
| Facility | | $5.75 | $12.30 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.89 / $8.71
| Professional | | $3.47 | $5.89 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.90 / $5.89
| Professional | | $3.55 | $4.90 | $5.89 |
- 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 / $6.17
| Professional | | $5.62 | $5.62 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $9.77 / $15.49
| Facility | | $5.62 | $9.77 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $6.76
| Professional | | $5.01 | $5.01 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.32 / $14.79
| Facility | | $6.46 | $8.32 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.01 / $5.62
| Professional | | $4.17 | $5.01 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.76 / $6.76
| Facility | | $5.01 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.24 / $7.08
| Professional | | $2.34 | $3.24 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.88 / $10.00
| Professional | | $2.51 | $2.88 | $10.00 |