- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $5.37
| Facility | | $1.86 | $1.86 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.69 / $123.03
| Professional | | $1.86 | $2.69 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.75 / $3.89
| Professional | | $2.24 | $2.75 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $61.66 / $131.83
| Professional | | $2.34 | $61.66 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.24 / $63.10
| Facility | | $1.58 | $2.24 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.78 / $1,819.70
| Professional | | $1.58 | $1.78 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.02 / $53.70
| Professional | | $2.40 | $3.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $97.72 / $117.49
| Professional | | $12.02 | $97.72 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.79 / $5.75
| Professional | | $2.45 | $4.79 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $12.30
| Facility | | $4.17 | $4.17 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.69 / $3.55
| Professional | | $2.51 | $2.69 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $3.02
| Facility | | $2.95 | $2.95 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.95 / $3.02
| Professional | | $2.29 | $2.95 | $3.02 |