- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $15.14 / $48.98
| Facility | | $2.63 | $15.14 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.75 / $7.94
| Professional | | $2.00 | $2.75 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.14 / $17.38
| Professional | | $2.04 | $2.14 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $13.18 / $13.18
| Facility | | $5.50 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.75 / $3.02
| Professional | | $2.29 | $2.75 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $6.03 / $13.80
| Facility | | $2.09 | $6.03 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.14 / $4.68
| Professional | | $1.51 | $2.14 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $5.13 / $9.55
| Professional | | $2.51 | $5.13 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.75 / $5.89
| Facility | | $2.45 | $2.75 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.24 / $3.55
| Professional | | $2.45 | $3.24 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $28.18
| Facility | | $13.80 | $13.80 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $3.02 / $5.37
| Facility | | $1.51 | $3.02 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.95 / $4.27
| Professional | | $1.82 | $2.95 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |