- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $19.05 / $46.77
| Facility | | $4.90 | $19.05 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.47 / $7.24
| Professional | | $3.98 | $4.47 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $3.63 / $8.32
| Professional | | $1.58 | $3.63 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $21.38
| Facility | | $12.88 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.72 / $4.57
| Professional | | $2.57 | $3.72 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $12.02 / $26.30
| Facility | | $3.89 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.63 / $8.51
| Professional | | $2.69 | $3.63 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $9.33 / $9.55
| Professional | | $4.17 | $9.33 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.57 / $9.77
| Facility | | $4.17 | $4.57 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.13 / $5.75
| Professional | | $4.07 | $5.13 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $5.75 / $8.71
| Facility | | $2.63 | $5.75 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.55 / $7.08
| Professional | | $2.40 | $3.55 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |