- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $7.08
| Facility | | $5.01 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $10.00
| Professional | | $7.08 | $7.94 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $22.91 / $41.69
| Facility | | $9.55 | $22.91 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.91 / $12.88
| Professional | | $6.76 | $8.91 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Facility | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $18.20
| Professional | | $7.94 | $10.96 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $177.83
| Professional | | $61.66 | $61.66 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $16.98
| Facility | | $7.08 | $10.00 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $14.13
| Professional | | $7.08 | $7.94 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.17 / $7.24
| Professional | | $5.13 | $6.17 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $20.42
| Professional | | $15.85 | $18.20 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $16.98
| Facility | | $7.08 | $10.00 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $17.78
| Professional | | $7.76 | $10.96 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $8.71
| Facility | | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $8.71 / $13.80
| Professional | | $6.61 | $8.71 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $8.13 / $9.77
| Professional | | $7.76 | $8.13 | $9.77 |