- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $8.13 / $12.02
| Facility | | $5.75 | $8.13 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.68 / $2,691.53
| Professional | | $3.02 | $4.68 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.57 / $9.33
| Facility | | $4.07 | $4.57 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.98 / $15.85
| Professional | | $3.89 | $3.98 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $16.22 / $21.38
| Facility | | $9.77 | $16.22 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $5.01 / $14.13
| Professional | | $3.89 | $5.01 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.46 / $8.71
| Facility | | $3.98 | $6.46 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $3.89
| Professional | | $3.80 | $3.80 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.27 / $8.71
| Professional | | $3.39 | $4.27 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $100.00
| Facility | | $85.11 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $3.89
| Professional | | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $6.17 / $9.55
| Facility | | $3.89 | $6.17 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $12.88
| Professional | | $3.80 | $3.80 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Professional | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.17 / $6.46
| Professional | | $3.02 | $4.17 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $26.92 / $26.92
| Facility | | $3.80 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $10.72
| Professional | | $3.89 | $3.89 | $10.72 |