- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $20.89 / $147.91
| Facility | | $5.13 | $20.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.13 / $60.26
| Professional | | $5.01 | $5.13 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $5.62
| Professional | | $5.50 | $5.50 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $8.71 / $13.49
| Facility | | $5.62 | $8.71 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.62 / $10.23
| Professional | | $5.13 | $5.62 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $5.62
| Professional | | $5.62 | $5.62 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $11.48 / $15.14
| Facility | | $7.24 | $11.48 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $5.62
| Professional | | $5.13 | $5.13 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.03 / $9.77
| Facility | | $5.25 | $6.03 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.62 / $97.72
| Professional | | $5.01 | $5.62 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $8.13
| Facility | | $6.92 | $6.92 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.25 / $6.03
| Professional | | $4.57 | $5.25 | $6.03 |