- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $20.89 / $81.28
| Facility | | $5.25 | $20.89 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $9.55
| Professional | | $3.98 | $5.01 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.39 / $3.80
| Professional | | $3.31 | $3.39 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $5.50 / $6.46
| Facility | | $4.90 | $5.50 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.50 / $8.13
| Professional | | $4.57 | $5.50 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $6.76 / $14.13
| Facility | | $3.89 | $6.76 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.75 / $10.96
| Professional | | $2.95 | $5.75 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $23.99 / $52.48
| Facility | | $5.50 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $7.76
| Professional | | $3.31 | $3.31 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $3.31
| Professional | | $2.63 | $2.63 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $4.47 / $6.76
| Facility | | $2.29 | $4.47 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.24 / $7.76
| Professional | | $2.29 | $3.24 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $5.50
| Professional | | $3.31 | $3.31 | $5.50 |