- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $23.44 / $190.55
| Facility | | $4.27 | $23.44 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.68 / $15.49
| Professional | | $2.00 | $4.68 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $11.48
| Facility | | $3.31 | $3.31 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $3.24 / $7.24
| Professional | | $1.32 | $3.24 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.79 / $5.37
| Facility | | $4.47 | $4.79 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.17 / $13.18
| Facility | | $3.16 | $6.17 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $3.16 / $8.51
| Professional | | $1.38 | $3.16 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $6.31 / $60.26
| Facility | | $2.95 | $6.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.95 / $4.27
| Professional | | $1.91 | $2.95 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $3.31 / $3.98
| Facility | | $1.35 | $3.31 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.63 / $4.68
| Professional | | $1.91 | $2.63 | $4.68 |