- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $91.20 / $870.96
| Facility | | $3.47 | $91.20 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $10.96 / $125.89
| Professional | | $2.00 | $10.96 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.09 / $3.89
| Professional | | $2.95 | $3.09 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.09 / $7.76
| Facility | | $2.95 | $3.09 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.24 / $5.89
| Professional | | $2.95 | $3.24 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.46 / $8.51
| Facility | | $4.07 | $6.46 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $3.31
| Professional | | $2.95 | $2.95 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.02 / $10.96
| Facility | | $2.09 | $3.02 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.34 / $537.03
| Professional | | $2.09 | $2.34 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $4.57
| Facility | | $3.89 | $3.89 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.09 / $37.15
| Professional | | $2.63 | $3.09 | $37.15 |