- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $28.18 / $91.20
| Facility | | $4.68 | $28.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.17 / $8.13
| Professional | | $3.02 | $4.17 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.17 / $7.41
| Professional | | $3.09 | $6.17 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $20.89 / $36.31
| Facility | | $7.94 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.90 / $6.03
| Professional | | $3.39 | $4.90 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $8.71 / $11.48
| Facility | | $5.50 | $8.71 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.41 / $7.41
| Facility | | $6.17 | $7.41 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $13.18 / $32.36
| Facility | | $6.61 | $13.18 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.17 / $11.22
| Professional | | $3.24 | $4.17 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.76 / $79.43
| Facility | | $4.68 | $6.76 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.50 / $10.23
| Professional | | $3.16 | $5.50 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.13 / $5.13
| Professional | | $4.57 | $5.13 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.17 / $18.62
| Facility | | $4.68 | $6.17 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.17 / $9.33
| Professional | | $3.24 | $4.17 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $6.17 / $7.41
| Facility | | $2.57 | $6.17 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.31 / $5.89
| Professional | | $2.57 | $3.31 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.16 / $6.17
| Professional | | $2.40 | $3.16 | $6.17 |