- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $28.18
| Facility | | $5.01 | $7.94 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $23.44
| Professional | | $3.02 | $3.98 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Facility | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Professional | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $27.54
| Facility | | $7.94 | $7.94 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $7.41
| Professional | | $6.03 | $6.03 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $75.86
| Professional | | $64.57 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $7.08 / $13.18
| Facility | | $4.37 | $7.08 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $22.39 / $22.39
| Facility | | $7.08 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.08 / $7.08
| Professional | | $5.13 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Facility | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Professional | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $10.72
| Facility | | $4.57 | $4.57 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $4.68
| Professional | | $3.98 | $3.98 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.03 / $7.94
| Professional | | $5.13 | $6.03 | $7.94 |