- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $7.41 / $20.42
| Facility | | $2.82 | $7.41 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $4.37
| Professional | | $2.00 | $3.02 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $12.30 / $20.89
| Facility | | $4.79 | $12.30 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.24 / $5.50
| Professional | | $2.19 | $3.24 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.98 / $3.98
| Facility | | $2.34 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.32 / $21.38
| Facility | | $4.27 | $8.32 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.69 / $6.17
| Professional | | $2.09 | $2.69 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.59
| Professional | | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.98 / $9.33
| Facility | | $2.95 | $3.98 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.80 / $5.89
| Professional | | $2.00 | $3.80 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.31 / $3.31
| Professional | | $2.95 | $3.31 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.98 / $11.75
| Facility | | $2.88 | $3.98 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.69 / $6.03
| Professional | | $2.09 | $2.69 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $3.98 / $4.79
| Facility | | $1.70 | $3.98 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $2.14 / $4.17
| Professional | | $1.66 | $2.14 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $2.04 / $3.98
| Professional | | $1.55 | $2.04 | $3.98 |