- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $7.94 / $34.67
| Facility | | $2.04 | $7.94 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $2.24 / $4.27
| Professional | | $1.35 | $2.24 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.78 / $3.55
| Professional | | $1.51 | $1.78 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.75 / $8.13
| Facility | | $5.62 | $5.75 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.66 / $5.37
| Professional | | $1.51 | $1.66 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $5.37 / $11.48
| Facility | | $1.74 | $5.37 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.78 / $3.98
| Professional | | $1.35 | $1.78 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.90 / $9.55
| Professional | | $2.09 | $4.90 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.29 / $5.01
| Facility | | $2.04 | $2.29 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.39 / $3.80
| Professional | | $2.04 | $3.39 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $6.46
| Facility | | $3.16 | $3.16 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $2.51 / $4.47
| Facility | | $1.35 | $2.51 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.78 / $3.55
| Professional | | $1.26 | $1.78 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |