- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $38.90 / $123.03
| Facility | | $2.51 | $38.90 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.51 / $13.49
| Professional | | $2.00 | $2.51 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.82 / $3.80
| Facility | | $2.45 | $2.82 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.75 / $2.82
| Professional | | $2.69 | $2.75 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.31 / $4.47
| Professional | | $2.75 | $3.31 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $12.88 / $81.28
| Facility | | $2.51 | $12.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.82 / $125.89
| Professional | | $2.51 | $2.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.39 / $3.80
| Professional | | $2.88 | $3.39 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $6.31 / $12.30
| Professional | | $2.88 | $6.31 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.55 / $7.76
| Facility | | $2.95 | $3.55 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.95 / $3.98
| Professional | | $2.51 | $2.95 | $3.98 |