- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $38.02 / $91.20
| Facility | | $9.77 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $25.12
| Professional | | $8.91 | $10.96 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $8.32 / $8.32
| Professional | | $5.13 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $53.70
| Facility | | $20.42 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $10.96
| Professional | | $7.94 | $7.94 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $54.95
| Facility | | $8.32 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $9.77 / $18.62
| Professional | | $6.17 | $9.77 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $22.39 / $33.11
| Professional | | $10.00 | $22.39 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $10.96 / $23.44
| Facility | | $9.77 | $10.96 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $16.22 / $17.78
| Professional | | $9.77 | $16.22 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $30.90
| Facility | | $15.14 | $15.14 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $12.02 / $21.38
| Facility | | $6.31 | $12.02 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $16.98
| Professional | | $6.03 | $8.51 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |