- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $27.54 / $218.78
| Facility | | $2.34 | $27.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.24
| Professional | | $2.00 | $2.00 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $3.39
| Professional | | $2.04 | $2.04 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.80 / $5.75
| Professional | | $3.39 | $3.80 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.80 / $5.13
| Facility | | $2.82 | $3.80 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.04 / $9.12
| Professional | | $1.74 | $2.04 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Professional | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.14 / $6.46
| Facility | | $2.04 | $2.14 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.14 / $2.95
| Facility | | $1.91 | $2.14 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.14 / $2.95
| Professional | | $1.91 | $2.14 | $2.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $3.47
| Facility | | $2.63 | $2.63 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.04 / $2.57
| Professional | | $1.58 | $2.04 | $2.57 |