- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $19.05 / $91.20
| Facility | | $2.69 | $19.05 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $7.41
| Professional | | $2.00 | $2.00 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $4.68
| Professional | | $2.69 | $2.69 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $3.09
| Professional | | $2.57 | $2.57 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $5.01 / $6.76
| Facility | | $2.82 | $5.01 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $2.69
| Professional | | $2.69 | $2.69 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.69 / $3.89
| Professional | | $2.29 | $2.69 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $6.76
| Professional | | $2.75 | $2.75 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.95 / $4.47
| Facility | | $2.29 | $2.95 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.55 / $5.01
| Professional | | $2.29 | $3.55 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.24 / $4.07
| Facility | | $2.51 | $3.24 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.24 / $4.07
| Professional | | $2.51 | $3.24 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.27 / $5.50
| Facility | | $3.72 | $4.27 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.75 / $3.02
| Professional | | $2.57 | $2.75 | $3.02 |