- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $46.77 / $147.91
| Facility | | $4.79 | $46.77 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.89
| Professional | | $3.02 | $3.02 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $2.40
| Professional | | $2.34 | $2.34 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.89 / $4.68
| Facility | | $3.47 | $3.89 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.89 / $5.75
| Professional | | $3.24 | $3.89 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.79 / $10.00
| Facility | | $2.75 | $4.79 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $4.07 / $7.76
| Professional | | $2.04 | $4.07 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.07 / $4.07
| Facility | | $2.63 | $4.07 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $5.50
| Professional | | $2.34 | $2.34 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.34
| Professional | | $1.91 | $1.91 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $3.24 / $4.79
| Facility | | $1.66 | $3.24 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $3.24 / $5.50
| Professional | | $1.78 | $3.24 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $3.89
| Professional | | $2.34 | $2.34 | $3.89 |