- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $17.38 / $63.10
| Facility | | $4.68 | $17.38 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.27 / $6.92
| Professional | | $3.98 | $4.27 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.47 / $3.47
| Professional | | $3.02 | $3.47 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $17.78
| Facility | | $11.75 | $14.79 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.63 / $4.37
| Professional | | $2.51 | $3.63 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $11.48 / $25.12
| Facility | | $3.80 | $11.48 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.31 / $8.13
| Professional | | $2.57 | $3.31 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $8.71 / $21.38
| Professional | | $3.89 | $8.71 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.27 / $9.33
| Facility | | $3.98 | $4.27 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.41 / $8.32
| Professional | | $3.80 | $7.41 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $5.62 / $8.32
| Facility | | $2.75 | $5.62 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.31 / $6.61
| Professional | | $2.75 | $3.31 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |