- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $14.45 / $66.07
| Facility | | $3.98 | $14.45 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $7.76
| Professional | | $3.02 | $3.98 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $18.62
| Facility | | $11.22 | $14.45 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.37 / $5.75
| Professional | | $4.27 | $4.37 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $12.02 / $26.30
| Facility | | $3.98 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.31 / $8.13
| Professional | | $2.75 | $3.31 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $9.33 / $15.49
| Professional | | $3.98 | $9.33 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.17 / $9.12
| Facility | | $3.98 | $4.17 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.92 / $7.76
| Professional | | $3.80 | $6.92 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $6.76 / $8.32
| Facility | | $2.88 | $6.76 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.57 / $6.61
| Professional | | $3.47 | $4.57 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |