- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $29.51
| Facility | | $7.08 | $11.48 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $10.23
| Professional | | $5.01 | $7.08 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $35.48 / $35.48
| Facility | | $19.50 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.75 / $7.59
| Professional | | $3.98 | $5.75 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $18.20 / $39.81
| Facility | | $6.03 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.03 / $13.49
| Professional | | $4.17 | $6.03 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $15.49 / $44.67
| Professional | | $6.92 | $15.49 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $7.59 / $16.22
| Facility | | $6.92 | $7.59 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $18.20 / $19.95
| Professional | | $5.25 | $18.20 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $8.71 / $14.45
| Facility | | $4.37 | $8.71 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.75 / $11.48
| Professional | | $4.37 | $5.75 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |