- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $69.18 / $199.53
| Facility | | $6.31 | $69.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.57 / $14.79
| Professional | | $3.98 | $4.57 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $6.31
| Professional | | $3.09 | $3.09 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.13 / $6.17
| Facility | | $4.57 | $5.13 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.13 / $7.59
| Professional | | $4.17 | $5.13 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $5.75 / $13.18
| Facility | | $3.63 | $5.75 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $5.37 / $10.47
| Professional | | $2.75 | $5.37 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $22.39 / $48.98
| Facility | | $5.13 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $7.24 / $10.23
| Professional | | $2.63 | $7.24 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.51 / $3.09
| Professional | | $2.51 | $2.51 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $4.27 / $6.46
| Facility | | $2.19 | $4.27 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.27 / $7.24
| Professional | | $2.34 | $4.27 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $3.09
| Professional | | $3.09 | $3.09 | $3.09 |