- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $38.90 / $138.04
| Facility | | $7.94 | $38.90 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $14.13
| Professional | | $3.02 | $3.98 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.88 / $5.75
| Professional | | $2.45 | $2.88 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.75 / $6.92
| Facility | | $5.13 | $5.75 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.75 / $8.13
| Professional | | $4.68 | $5.75 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $5.25 / $14.79
| Facility | | $3.31 | $5.25 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.79 / $10.47
| Professional | | $2.82 | $4.79 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $18.20 / $40.74
| Facility | | $4.27 | $18.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $6.03 / $8.51
| Professional | | $2.69 | $6.03 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.47
| Professional | | $2.82 | $2.82 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.47 / $5.75
| Facility | | $2.45 | $3.47 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.47 / $6.03
| Professional | | $2.63 | $3.47 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $3.47
| Professional | | $3.47 | $3.47 | $3.47 |