- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $87.10 / $223.87
| Facility | | $16.98 | $87.10 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.25 / $10.96
| Professional | | $3.98 | $5.25 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.72 / $4.17
| Professional | | $3.63 | $3.72 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.03 / $7.08
| Facility | | $5.25 | $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
- $4.17 / $7.24 / $15.49
| Facility | | $4.17 | $7.24 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $6.03 / $11.75
| Professional | | $3.24 | $6.03 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $25.70 / $56.23
| Facility | | $6.03 | $25.70 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $8.32
| Professional | | $3.63 | $3.63 | $8.32 |
- 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
- $2.51 / $3.55 / $8.32
| Professional | | $2.51 | $3.55 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $6.03
| Professional | | $3.63 | $3.63 | $6.03 |