- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $33.11 / $74.13
| Facility | | $4.07 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.55 / $6.61
| Professional | | $3.02 | $3.55 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $8.91
| Professional | | $2.75 | $2.75 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.71 / $17.38
| Facility | | $8.32 | $8.71 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $3.55
| Professional | | $2.57 | $2.57 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $8.13 / $17.78
| Facility | | $2.69 | $8.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.09 / $6.17
| Professional | | $2.00 | $3.09 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $7.24 / $9.77
| Professional | | $3.24 | $7.24 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.55 / $7.76
| Facility | | $3.16 | $3.55 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $3.24
| Professional | | $2.88 | $2.88 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,235.94 / $3,630.78
| Facility | | $3,019.95 | $3,235.94 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.98 / $6.92
| Facility | | $2.04 | $3.98 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.75 / $5.50
| Professional | | $2.00 | $2.75 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |