- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $64.57 / $281.84
| Facility | | $5.62 | $64.57 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.01
| Professional | | $3.02 | $3.02 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $18.62
| Facility | | $7.59 | $9.55 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.75 / $3.89
| Professional | | $2.57 | $2.75 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.71 / $19.50
| Facility | | $2.95 | $8.71 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.95 / $6.76
| Professional | | $2.19 | $2.95 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $8.32 / $21.38
| Professional | | $2.40 | $8.32 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.89 / $8.32
| Facility | | $3.39 | $3.89 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $7.24 / $7.94
| Professional | | $3.39 | $7.24 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $5.62 / $8.13
| Facility | | $2.24 | $5.62 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.95 / $7.76
| Professional | | $2.14 | $2.95 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $100.00
| Facility | | $66.07 | $66.07 | $100.00 |