- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $14.13 / $54.95
| Facility | | $5.13 | $14.13 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.24 / $28.84
| Professional | | $3.02 | $7.24 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $14.79
| Facility | | $4.27 | $4.27 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.98 / $11.22
| Professional | | $2.09 | $3.98 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $8.13 / $9.55
| Facility | | $6.46 | $8.13 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.13 / $23.44
| Facility | | $5.75 | $8.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.17 / $10.96
| Professional | | $2.34 | $4.17 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $9.33 / $100.00
| Facility | | $3.80 | $9.33 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.57 / $5.37
| Professional | | $1.78 | $2.57 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $4.27 / $5.25
| Facility | | $1.91 | $4.27 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.57 / $5.62
| Professional | | $1.78 | $2.57 | $5.62 |