- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $28.84 / $54.95
| Facility | | $4.79 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.37 / $6.31
| Professional | | $3.63 | $4.37 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $3.39 / $15.14
| Professional | | $1.38 | $3.39 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $20.89 / $20.89
| Facility | | $11.22 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.31 / $4.37
| Professional | | $2.29 | $3.31 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $10.72 / $22.91
| Facility | | $3.47 | $10.72 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.55 / $7.94
| Professional | | $2.51 | $3.55 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $8.71 / $9.12
| Professional | | $4.07 | $8.71 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.37 / $9.55
| Facility | | $4.07 | $4.37 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $5.25 / $5.75
| Professional | | $3.89 | $5.25 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $5.01 / $8.51
| Facility | | $2.51 | $5.01 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.39 / $6.92
| Professional | | $2.14 | $3.39 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |