- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $58.88 / $190.55
| Facility | | $8.71 | $58.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.89 / $13.49
| Professional | | $5.01 | $5.89 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.07 / $4.57
| Professional | | $2.82 | $4.07 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $6.61 / $7.76
| Facility | | $5.89 | $6.61 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.61 / $9.77
| Professional | | $5.25 | $6.61 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $8.13 / $16.98
| Facility | | $4.68 | $8.13 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $6.17 / $12.88
| Professional | | $3.39 | $6.17 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $28.18 / $63.10
| Facility | | $6.61 | $28.18 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $9.33
| Professional | | $3.98 | $3.98 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.98
| Professional | | $3.16 | $3.16 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $5.37 / $8.13
| Facility | | $2.75 | $5.37 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.89 / $9.33
| Professional | | $2.75 | $3.89 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $6.61
| Professional | | $3.98 | $3.98 | $6.61 |