- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $17.38 / $69.18
| Facility | | $4.37 | $17.38 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.46
| Professional | | $3.02 | $3.98 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.82
| Professional | | $2.29 | $2.29 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.68 / $5.50
| Facility | | $4.07 | $4.68 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.68 / $6.76
| Professional | | $3.89 | $4.68 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $5.62 / $12.02
| Facility | | $3.24 | $5.62 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $5.01 / $8.71
| Professional | | $2.45 | $5.01 | $8.71 |
- 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
- $2.75 / $2.75 / $6.46
| Professional | | $2.75 | $2.75 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.75
| Professional | | $2.24 | $2.24 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $4.17 / $5.75
| Facility | | $1.95 | $4.17 | $5.75 |
- 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 / $4.68
| Professional | | $2.75 | $2.75 | $4.68 |