- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Facility | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $6.03 / $7.94
| Professional | | $4.37 | $6.03 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.13 / $29.51
| Professional | | $8.71 | $14.13 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $75.86
| Facility | | $40.74 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $16.98 / $20.89
| Professional | | $7.41 | $16.98 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.08 / $15.85
| Facility | | $5.13 | $7.08 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $38.02 / $52.48
| Professional | | $9.55 | $38.02 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.76 / $18.62
| Facility | | $5.13 | $7.76 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.62 / $69.18
| Professional | | $5.13 | $5.62 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Professional | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $19.05 / $28.84
| Professional | | $9.55 | $19.05 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $89.13
| Facility | | $30.20 | $30.20 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $14.79 / $72.44
| Professional | | $7.08 | $14.79 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.22 / $17.78
| Professional | | $15.14 | $16.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $5.37 / $10.00
| Professional | | $3.55 | $5.37 | $10.00 |