- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $13.18 / $112.20
| Facility | | $3.80 | $13.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $30.90
| Professional | | $2.00 | $3.02 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.80 / $3.80
| Professional | | $2.00 | $3.80 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.98 / $6.92
| Facility | | $3.47 | $3.98 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.19 / $4.79
| Professional | | $1.70 | $2.19 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $2.57
| Facility | | $2.57 | $2.57 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.98 / $4.79
| Facility | | $2.57 | $3.98 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.80 / $5.13
| Professional | | $2.45 | $3.80 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.57 / $15.85
| Facility | | $2.51 | $4.57 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.75 / $6.61
| Professional | | $1.82 | $2.75 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $27.54 / $109.65
| Facility | | $3.31 | $27.54 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $3.39 / $29.51
| Professional | | $1.51 | $3.39 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.39 / $4.68
| Professional | | $2.82 | $3.39 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $4.57
| Facility | | $4.57 | $4.57 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.98 / $7.76
| Professional | | $2.63 | $3.98 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $3.80 / $5.75
| Facility | | $1.91 | $3.80 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.29 / $4.79
| Professional | | $1.58 | $2.29 | $4.79 |