- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $29.51 / $91.20
| Facility | | $5.62 | $29.51 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $4.47
| Professional | | $3.02 | $3.02 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $7.41
| Professional | | $4.47 | $4.47 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.08 / $10.72
| Professional | | $6.17 | $7.08 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $11.22
| Facility | | $6.17 | $8.32 | $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
- $3.24 / $3.80 / $17.78
| Professional | | $3.24 | $3.80 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $3.02 / $7.94
| Facility | | $0.81 | $3.02 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.37 / $17.38
| Facility | | $4.27 | $5.37 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.37 / $17.38
| Professional | | $4.27 | $5.37 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $10.00
| Facility | | $7.59 | $7.59 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.02 / $5.75
| Professional | | $2.95 | $3.02 | $5.75 |