- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $38.90 / $87.10
| Facility | | $5.01 | $38.90 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.13 / $9.55
| Professional | | $3.98 | $5.13 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.98 / $44.67
| Professional | | $3.80 | $3.98 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.78 / $21.38
| Facility | | $12.02 | $17.78 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $5.25
| Professional | | $3.72 | $3.72 | $5.25 |
- 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
- $3.02 / $4.68 / $8.91
| Professional | | $3.02 | $4.68 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.79 / $10.72
| Professional | | $3.98 | $4.79 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.25 / $11.22
| Facility | | $4.57 | $5.25 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $7.24 / $8.13
| Professional | | $4.57 | $7.24 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.75 / $10.00
| Facility | | $2.88 | $5.75 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.98 / $7.94
| Professional | | $2.40 | $3.98 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |