- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $17.38 / $64.57
| Facility | | $3.72 | $17.38 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $8.13
| Professional | | $3.02 | $3.98 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.02 / $9.77
| Professional | | $2.63 | $3.02 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $18.62 / $18.62
| Facility | | $9.77 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.98
| Professional | | $2.82 | $2.82 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $8.71 / $19.95
| Facility | | $3.02 | $8.71 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.47 / $6.76
| Professional | | $2.19 | $3.47 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $6.03 / $8.13
| Professional | | $3.63 | $6.03 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.98 / $8.51
| Facility | | $3.47 | $3.98 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.63 / $4.07
| Professional | | $3.47 | $3.63 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $6,165.95
| Facility | | $2,951.21 | $2,951.21 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $4.37 / $7.59
| Facility | | $2.24 | $4.37 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.02 / $6.03
| Professional | | $2.19 | $3.02 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |