- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $75.86 / $891.25
| Facility | | $9.12 | $75.86 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $8.51 / $40.74
| Professional | | $3.39 | $8.51 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.47 / $4.57
| Professional | | $3.89 | $4.47 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $32.36
| Facility | | $9.33 | $9.33 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.72 / $10.23
| Professional | | $2.45 | $3.72 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.50 / $6.17
| Facility | | $5.13 | $5.50 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.57 / $15.14
| Facility | | $3.47 | $4.57 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.68 / $8.51
| Professional | | $2.63 | $4.68 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $19.05 / $467.74
| Facility | | $4.90 | $19.05 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.55 / $6.03
| Professional | | $1.82 | $3.55 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $9.33 / $10.72
| Facility | | $1.26 | $9.33 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.02 / $6.92
| Professional | | $1.82 | $3.02 | $6.92 |