- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.51 / $11.22
| Professional | | $7.08 | $8.51 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $15.49 / $30.90
| Facility | | $6.76 | $15.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $12.59 / $12.59
| Professional | | $4.17 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.66 / $3.09
| Facility | | $1.58 | $1.66 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.46 / $6.46
| Professional | | $4.68 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $64.57 / $75.86
| Professional | | $10.00 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.89 / $20.89
| Facility | | $19.50 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $28.18
| Facility | | $11.22 | $17.78 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.50 / $28.18
| Professional | | $14.13 | $19.50 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.49 / $33.88
| Facility | | $12.88 | $15.49 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $12.59 / $12.59
| Professional | | $4.17 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.59 / $12.59
| Facility | | $12.02 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $26.92
| Professional | | $10.23 | $13.80 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.62 / $22.39
| Professional | | $5.37 | $5.62 | $22.39 |