- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $47.86 / $141.25
| Facility | | $4.90 | $47.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $6.03
| Professional | | $3.02 | $3.02 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.45 / $2.45
| Professional | | $2.45 | $2.45 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.98 / $4.68
| Facility | | $3.55 | $3.98 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.98 / $5.37
| Professional | | $3.31 | $3.98 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $4.07 / $10.23
| Facility | | $2.57 | $4.07 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.72 / $7.08
| Professional | | $2.04 | $3.72 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.80 / $3.80
| Facility | | $2.63 | $3.80 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $5.13 / $7.24
| Professional | | $2.00 | $5.13 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.40
| Professional | | $1.91 | $1.91 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $3.02 / $4.57
| Facility | | $1.70 | $3.02 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.14 / $5.13
| Professional | | $1.70 | $2.14 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |