- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $66.07 / $1,288.25
| Facility | | $2.82 | $66.07 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.47 / $75.86
| Professional | | $2.00 | $3.47 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.75 / $2.95
| Professional | | $2.34 | $2.75 | $2.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.88 / $7.24
| Facility | | $2.75 | $2.88 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.16 / $5.62
| Professional | | $2.75 | $3.16 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.03 / $7.94
| Facility | | $3.80 | $6.03 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $3.09
| Professional | | $2.75 | $2.75 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.80 / $8.32
| Facility | | $2.69 | $3.80 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.02 / $169.82
| Professional | | $2.69 | $3.02 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $4.90
| Facility | | $4.27 | $4.27 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.16 / $5.37
| Professional | | $2.69 | $3.16 | $5.37 |