- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $29.51 / $69.18
| Facility | | $5.62 | $29.51 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $7.76
| Professional | | $3.02 | $3.98 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.09 / $3.16
| Professional | | $2.75 | $3.09 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.57 / $5.37
| Facility | | $4.07 | $4.57 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.57 / $6.76
| Professional | | $3.80 | $4.57 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.13 / $11.75
| Facility | | $3.16 | $5.13 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $4.68 / $9.12
| Professional | | $2.40 | $4.68 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $19.95 / $43.65
| Facility | | $4.57 | $19.95 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $6.46 / $9.12
| Professional | | $2.29 | $6.46 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.75
| Professional | | $2.19 | $2.19 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.80 / $5.62
| Facility | | $1.95 | $3.80 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.69 / $6.46
| Professional | | $1.95 | $2.69 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |