- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.27 / $89.13
| Facility | | $2.09 | $4.27 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.55 / $53.70
| Professional | | $2.00 | $3.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.09 / $4.37
| Professional | | $2.09 | $2.09 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.03 / $6.17
| Facility | | $4.57 | $6.03 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.48 / $12.02
| Professional | | $11.22 | $11.48 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.63 / $4.27
| Professional | | $2.19 | $2.63 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.16 / $5.37
| Facility | | $1.95 | $3.16 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.95 / $147.91
| Professional | | $1.95 | $2.95 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.47 / $4.17
| Professional | | $2.95 | $3.47 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.07 / $4.90
| Professional | | $2.82 | $4.07 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.47 / $7.59
| Facility | | $2.19 | $3.47 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.88 / $11.48
| Professional | | $2.09 | $2.88 | $11.48 |