- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $15.85 / $57.54
| Facility | | $4.27 | $15.85 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.27 / $6.31
| Professional | | $3.02 | $4.27 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.31 / $6.76
| Professional | | $2.82 | $3.31 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $11.22 / $20.89
| Facility | | $10.72 | $11.22 | $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 / $3.31 / $7.76
| Professional | | $2.51 | $3.31 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $8.71 / $14.13
| Professional | | $3.98 | $8.71 | $14.13 |
- 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 / $4.68 / $5.25
| Professional | | $3.80 | $4.68 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $5.13 / $8.32
| Facility | | $2.51 | $5.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.31 / $6.61
| Professional | | $2.14 | $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 |