- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $131.83 / $281.84
| Facility | | $5.01 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $60.26
| Professional | | $5.01 | $5.01 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $9.77
| Professional | | $5.13 | $5.13 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.38 / $6.61
| Facility | | $1.23 | $1.38 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.89 / $7.59
| Professional | | $5.13 | $5.89 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $13.18
| Facility | | $7.24 | $7.24 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $5.37
| Professional | | $5.13 | $5.13 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $4.17 / $4.47
| Professional | | $1.07 | $4.17 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $5.13 / $7.41
| Facility | | $1.35 | $5.13 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.80 / $30.20
| Professional | | $13.49 | $13.80 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $8.51
| Facility | | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.50 / $5.75
| Professional | | $4.37 | $5.50 | $5.75 |