- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.17 / $19.50
| Facility | | $3.98 | $6.17 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.03
| Professional | | $3.02 | $3.98 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $18.20
| Facility | | $12.88 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.80 / $3.98
| Professional | | $2.63 | $3.80 | $3.98 |
- 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
- $2.63 / $3.09 / $7.76
| Professional | | $2.63 | $3.09 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $16.60
| Professional | | $3.55 | $3.55 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.27 / $8.32
| Facility | | $3.47 | $4.27 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.07 / $4.57
| Professional | | $3.80 | $4.07 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $6.03 / $7.41
| Facility | | $2.88 | $6.03 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.09 / $7.41
| Professional | | $2.63 | $3.09 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |