- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $33.88 / $109.65
| Facility | | $5.37 | $33.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.55 / $7.24
| Professional | | $3.02 | $3.55 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.79 / $17.78
| Facility | | $10.00 | $14.79 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.37 / $5.50
| Professional | | $3.55 | $4.37 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $10.00 / $21.88
| Facility | | $3.31 | $10.00 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.31 / $7.41
| Professional | | $2.51 | $3.31 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $9.33 / $9.55
| Professional | | $3.98 | $9.33 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.27 / $9.33
| Facility | | $3.80 | $4.27 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $8.91 / $10.00
| Professional | | $3.80 | $8.91 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $5.25 / $8.32
| Facility | | $2.51 | $5.25 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.31 / $6.61
| Professional | | $2.40 | $3.31 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |