- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $50.12 / $95.50
| Facility | | $7.76 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.08 / $13.18
| Professional | | $6.03 | $7.08 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $11.48
| Professional | | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $35.48 / $35.48
| Facility | | $17.38 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.37 / $7.41
| Professional | | $5.37 | $5.37 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $16.98 / $37.15
| Facility | | $5.62 | $16.98 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.62 / $12.30
| Professional | | $4.17 | $5.62 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $15.14 / $23.99
| Professional | | $6.76 | $15.14 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $7.41 / $15.85
| Facility | | $6.61 | $7.41 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $5.01
| Professional | | $4.47 | $4.47 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $8.13 / $14.45
| Facility | | $4.07 | $8.13 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $7.94 / $11.48
| Professional | | $4.90 | $7.94 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |