- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.55 / $24.55
| Facility | | $5.13 | $9.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.25 / $7.94
| Professional | | $3.98 | $5.25 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $22.91 / $32.36
| Facility | | $12.30 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.79 / $12.30
| Professional | | $3.31 | $4.79 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $15.49 / $33.11
| Facility | | $5.01 | $15.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.13 / $11.48
| Professional | | $3.72 | $5.13 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $13.49 / $97.72
| Professional | | $6.03 | $13.49 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $7.94 / $14.13
| Facility | | $5.89 | $7.94 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $6.31 / $7.08
| Professional | | $5.89 | $6.31 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $8.71 / $12.88
| Facility | | $3.80 | $8.71 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $5.13 / $11.22
| Professional | | $3.63 | $5.13 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |