- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $5.75 / $81.28
| Facility | | $3.02 | $5.75 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.01
| Professional | | $3.02 | $3.02 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $18.62 / $18.62
| Facility | | $9.55 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.82 / $9.12
| Professional | | $2.57 | $2.82 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.71 / $19.50
| Facility | | $2.95 | $8.71 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.95 / $6.46
| Professional | | $2.19 | $2.95 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.59
| Professional | | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.89 / $8.32
| Facility | | $2.57 | $3.89 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.75 / $6.03
| Professional | | $3.47 | $5.75 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $4.27 / $7.59
| Facility | | $2.24 | $4.27 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.02 / $6.03
| Professional | | $2.14 | $3.02 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |