- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $45.71 / $165.96
| Facility | | $5.13 | $45.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.68 / $14.79
| Professional | | $3.31 | $4.68 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.55 / $11.48
| Professional | | $3.09 | $3.55 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $16.22
| Facility | | $8.71 | $11.48 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $4.68
| Professional | | $3.31 | $3.31 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $10.72 / $23.44
| Facility | | $3.55 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.63 / $7.94
| Professional | | $2.69 | $3.63 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $6.03 / $9.55
| Professional | | $4.27 | $6.03 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.68 / $10.00
| Facility | | $4.07 | $4.68 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.37 / $5.89
| Professional | | $4.07 | $5.37 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $912.01
| Facility | | $549.54 | $851.14 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $5.13 / $8.91
| Facility | | $2.57 | $5.13 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.55 / $7.08
| Professional | | $2.14 | $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 |