- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.55 / $190.55
| Facility | | $2.57 | $3.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.31 / $8.51
| Professional | | $2.00 | $3.31 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.69 / $3.31
| Professional | | $2.63 | $2.69 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $7.24 / $12.88
| Professional | | $2.82 | $7.24 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.02 / $4.17
| Facility | | $2.24 | $3.02 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.51 / $40.74
| Professional | | $2.24 | $2.51 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.16 / $4.37
| Professional | | $2.95 | $3.16 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.25 / $5.50
| Professional | | $2.95 | $5.25 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.57 / $5.75
| Professional | | $2.82 | $4.57 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.27
| Facility | | $4.17 | $4.17 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.69 / $3.31
| Professional | | $2.57 | $2.69 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.09
| Facility | | $2.82 | $2.82 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.82 / $3.09
| Professional | | $2.24 | $2.82 | $3.09 |