- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $19.95 / $75.86
| Facility | | $4.17 | $19.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.89 / $6.31
| Professional | | $3.02 | $3.89 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.69 / $3.09
| Professional | | $2.63 | $2.69 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.37 / $5.13
| Facility | | $3.89 | $4.37 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.37 / $6.46
| Professional | | $3.63 | $4.37 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $5.37 / $11.22
| Facility | | $3.09 | $5.37 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.57 / $9.12
| Professional | | $2.34 | $4.57 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $19.05 / $41.69
| Facility | | $4.37 | $19.05 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $6.17
| Professional | | $2.63 | $2.63 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.14 / $2.63
| Professional | | $2.09 | $2.14 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.63 / $5.50
| Facility | | $1.86 | $3.63 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.57 / $6.17
| Professional | | $1.86 | $2.57 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $4.37
| Professional | | $2.63 | $2.63 | $4.37 |