- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.23 / $25.70
| Facility | | $5.50 | $10.23 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $3.98
| Professional | | $3.02 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.01 / $9.55
| Facility | | $4.37 | $5.01 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.37 / $8.13
| Professional | | $4.17 | $4.37 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.90 / $6.46
| Facility | | $4.17 | $4.90 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.37 / $10.96
| Professional | | $4.17 | $5.37 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $8.71 / $10.96
| Facility | | $4.47 | $8.71 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $398.11
| Professional | | $5.01 | $7.94 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.89 / $11.22
| Facility | | $4.47 | $5.89 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.37 / $7.08
| Professional | | $4.17 | $5.37 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $7.94 / $7.94
| Facility | | $2.34 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $10.72
| Professional | | $4.37 | $4.37 | $10.72 |