- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $47.86 / $275.42
| Facility | | $5.75 | $47.86 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $19.95
| Professional | | $3.98 | $5.01 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.31
| Professional | | $3.24 | $3.24 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.37 / $6.31
| Facility | | $4.79 | $5.37 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.37 / $7.76
| Professional | | $4.47 | $5.37 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.61 / $13.80
| Facility | | $3.80 | $6.61 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $5.25 / $10.96
| Professional | | $2.75 | $5.25 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $22.91 / $50.12
| Facility | | $5.37 | $22.91 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $7.59
| Professional | | $3.24 | $3.24 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $3.24
| Professional | | $2.57 | $2.57 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $4.37 / $6.61
| Facility | | $2.24 | $4.37 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.16 / $7.59
| Professional | | $2.24 | $3.16 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $5.37
| Professional | | $3.24 | $3.24 | $5.37 |