- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $19.05 / $63.10
| Facility | | $6.76 | $19.05 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $5.01 / $30.20
| Professional | | $3.02 | $5.01 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.24
| Professional | | $2.24 | $2.24 | $2.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $47.86
| Facility | | $18.62 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $7.59
| Professional | | $5.01 | $7.08 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.91 / $11.22
| Professional | | $2.95 | $8.91 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $12.88 / $89.13
| Facility | | $2.75 | $12.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.75 / $5.01
| Professional | | $2.04 | $2.75 | $5.01 |
- 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
- $5.62 / $5.62 / $5.62
| Facility | | $5.62 | $5.62 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.75 / $6.17
| Facility | | $1.95 | $2.75 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.75 / $5.01
| Professional | | $2.63 | $2.75 | $5.01 |