- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.59 / $16.60
| Facility | | $3.02 | $7.59 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $5.01
| Professional | | $3.02 | $3.98 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $21.38 / $21.38
| Facility | | $12.02 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.24 / $6.61
| Professional | | $2.24 | $3.24 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $10.00 / $22.39
| Facility | | $3.55 | $10.00 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.31 / $6.61
| Professional | | $2.95 | $3.31 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Professional | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.25 / $9.77
| Facility | | $3.98 | $5.25 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.72
| Professional | | $3.24 | $3.24 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $5.89 / $8.71
| Facility | | $2.63 | $5.89 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.55 / $7.08
| Professional | | $2.45 | $3.55 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $85.11
| Facility | | $75.86 | $75.86 | $85.11 |