- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $13.49 / $46.77
| Facility | | $4.57 | $13.49 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.57 / $7.24
| Professional | | $3.98 | $4.57 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.47 / $3.63
| Professional | | $3.09 | $3.47 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $16.22 / $22.91
| Facility | | $9.77 | $16.22 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.80 / $4.68
| Professional | | $2.57 | $3.80 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $12.02 / $26.30
| Facility | | $3.98 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.72 / $8.51
| Professional | | $2.75 | $3.72 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $9.55 / $23.44
| Professional | | $4.27 | $9.55 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.68 / $10.00
| Facility | | $4.27 | $4.68 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $7.76 / $8.51
| Professional | | $4.17 | $7.76 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.75 / $9.12
| Facility | | $2.88 | $5.75 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.63 / $7.24
| Professional | | $2.88 | $3.63 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |