- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $48.98 / $141.25
| Facility | | $6.92 | $48.98 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.37 / $15.14
| Professional | | $3.98 | $5.37 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $6.03 / $6.03
| Professional | | $3.63 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $6.03 / $7.08
| Facility | | $5.37 | $6.03 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $8.71
| Professional | | $5.01 | $6.03 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $7.41 / $15.49
| Facility | | $4.27 | $7.41 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $6.46 / $11.75
| Professional | | $3.24 | $6.46 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $25.70 / $57.54
| Facility | | $6.03 | $25.70 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $8.51
| Professional | | $3.63 | $3.63 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $3.63
| Professional | | $2.88 | $2.88 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.90 / $7.41
| Facility | | $2.51 | $4.90 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.55 / $8.51
| Professional | | $2.09 | $3.55 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $6.03
| Professional | | $3.63 | $3.63 | $6.03 |