- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $20.42 / $85.11
| Facility | | $3.39 | $20.42 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.98 / $11.75
| Professional | | $2.63 | $3.98 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $3.47 / $9.55
| Professional | | $1.07 | $3.47 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $15.49
| Facility | | $9.55 | $9.55 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $7.41
| Professional | | $2.75 | $3.80 | $7.41 |
- 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
- $2.00 / $2.95 / $5.89
| Professional | | $2.00 | $2.95 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.55 / $6.92
| Professional | | $2.95 | $3.55 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.09 / $6.92
| Facility | | $2.95 | $3.09 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.57 / $5.01
| Professional | | $2.82 | $4.57 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $95.50
| Facility | | $58.88 | $58.88 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.27 / $6.17
| Facility | | $2.09 | $4.27 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.47 / $5.13
| Professional | | $2.57 | $3.47 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |