- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $21.88 / $83.18
| Facility | | $3.80 | $21.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $6.03
| Professional | | $2.00 | $3.02 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $14.13 / $27.54
| Facility | | $5.13 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.79 / $5.50
| Professional | | $2.63 | $4.79 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $8.71 / $31.62
| Facility | | $4.47 | $8.71 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.90 / $7.59
| Professional | | $2.82 | $4.90 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $4.79
| Facility | | $4.68 | $4.68 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.47 / $25.12
| Facility | | $5.50 | $10.47 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $8.13
| Professional | | $2.75 | $3.47 | $8.13 |
- 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
- $9.33 / $9.33 / $9.33
| Professional | | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.79 / $43.65
| Facility | | $3.63 | $4.79 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.07 / $8.13
| Professional | | $2.00 | $4.07 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.98 / $3.98
| Professional | | $3.55 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.79 / $13.80
| Facility | | $3.72 | $4.79 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.39 / $7.94
| Professional | | $2.51 | $3.39 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $4.79 / $5.75
| Facility | | $2.14 | $4.79 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.82 / $5.25
| Professional | | $2.00 | $2.82 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.45 / $4.79
| Professional | | $1.86 | $2.45 | $4.79 |