- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $33.88 / $69.18
| Facility | | $3.39 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.80 / $6.92
| Professional | | $3.02 | $3.80 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.95 / $2.95
| Professional | | $2.57 | $2.95 | $2.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $18.20 / $18.20
| Facility | | $9.55 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.89 / $4.27
| Professional | | $3.02 | $3.89 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.71 / $19.50
| Facility | | $2.95 | $8.71 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.95 / $6.46
| Professional | | $2.19 | $2.95 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.32 / $8.32
| Professional | | $7.41 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.89 / $8.32
| Facility | | $3.39 | $3.89 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.37 / $5.75
| Professional | | $3.47 | $4.37 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $5.62 / $7.41
| Facility | | $2.24 | $5.62 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $4.27 / $6.03
| Professional | | $2.57 | $4.27 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |