- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $15.14 / $19.95
| Facility | | $6.61 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $16.98
| Professional | | $6.03 | $6.03 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.08 / $5,011.87
| Facility | | $6.03 | $7.08 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $23.44 / $25.12
| Facility | | $6.76 | $23.44 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Facility | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $11.75
| Professional | | $10.00 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $12.88
| Facility | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $10.23 / $17.38
| Facility | | $6.03 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $7.76
| Professional | | $6.03 | $6.03 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $8.71
| Facility | | $7.08 | $7.94 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.51 / $11.48
| Professional | | $7.41 | $8.51 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Facility | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $12.02
| Professional | | $6.46 | $6.46 | $12.02 |