- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $21.88 / $97.72
| Facility | | $5.62 | $21.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $6.17
| Professional | | $3.98 | $3.98 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.59 / $22.91
| Facility | | $3.80 | $7.59 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.27 / $7.59
| Professional | | $3.55 | $4.27 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $4.79
| Facility | | $4.79 | $4.79 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $4.79
| Facility | | $4.79 | $4.79 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $7.59 / $11.75
| Facility | | $6.76 | $7.59 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $5.37
| Professional | | $3.55 | $3.55 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $10.00 / $52.48
| Facility | | $4.47 | $10.00 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $11.22
| Professional | | $4.79 | $4.79 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.89 / $6.92
| Professional | | $4.79 | $5.89 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.03 / $8.32
| Professional | | $3.31 | $6.03 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $10.72 / $10.72
| Facility | | $6.17 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $5.62
| Professional | | $4.79 | $4.79 | $5.62 |