- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $31.62 / $77.62
| Facility | | $3.09 | $31.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.16 / $5.75
| Professional | | $2.00 | $3.16 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $2.14 / $2.51
| Professional | | $1.38 | $2.14 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $15.49 / $15.49
| Facility | | $7.94 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.47 / $3.47
| Professional | | $2.34 | $3.47 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $7.41 / $16.22
| Facility | | $2.51 | $7.41 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.45 / $5.62
| Professional | | $1.86 | $2.45 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $6.61 / $7.59
| Professional | | $2.95 | $6.61 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.24 / $7.08
| Facility | | $2.88 | $3.24 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $7.76 / $8.32
| Professional | | $2.88 | $7.76 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.55 / $6.31
| Facility | | $1.86 | $3.55 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.47 / $5.01
| Professional | | $2.14 | $3.47 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |