- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.92 / $53.70
| Facility | | $10.00 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $37.15
| Professional | | $3.98 | $5.01 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $13.49 / $28.84
| Facility | | $2.69 | $13.49 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $5.89 / $14.79
| Professional | | $2.34 | $5.89 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $38.90 / $79.43
| Facility | | $12.59 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.37 / $16.22
| Professional | | $3.80 | $5.37 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $10.23 / $19.95
| Facility | | $4.07 | $10.23 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.03 / $11.75
| Professional | | $3.09 | $6.03 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.75 / $9.33
| Professional | | $4.68 | $5.75 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.75 / $13.18
| Professional | | $4.68 | $5.75 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $6.92
| Professional | | $3.47 | $3.47 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.76 / $15.14
| Facility | | $4.17 | $6.76 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.79 / $11.75
| Professional | | $3.09 | $4.79 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.89 / $9.77
| Professional | | $4.68 | $5.89 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.47 / $6.92
| Facility | | $2.63 | $3.47 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.07 / $10.96
| Professional | | $3.47 | $4.07 | $10.96 |