- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $20.89 / $67.61
| Facility | | $4.57 | $20.89 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.89 / $7.08
| Professional | | $3.02 | $3.89 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.37 / $4.37
| Professional | | $2.63 | $4.37 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.37 / $5.13
| Facility | | $3.89 | $4.37 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.37 / $6.31
| Professional | | $3.47 | $4.37 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.90 / $11.22
| Facility | | $3.02 | $4.90 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $4.37 / $8.51
| Professional | | $2.29 | $4.37 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $14.13 / $30.90
| Facility | | $4.37 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $6.03 / $8.71
| Professional | | $2.19 | $6.03 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.09 / $2.63
| Professional | | $2.09 | $2.09 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.55 / $5.37
| Facility | | $1.82 | $3.55 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.51 / $6.03
| Professional | | $1.82 | $2.51 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $2.63
| Professional | | $2.63 | $2.63 | $2.63 |