- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $40.74 / $89.13
| Facility | | $5.25 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.88 / $7.94
| Professional | | $2.24 | $2.88 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $8.32 / $11.48
| Facility | | $5.13 | $8.32 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.63 / $6.03
| Professional | | $2.14 | $3.63 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.08 / $7.76
| Professional | | $6.17 | $7.08 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $22.39 / $87.10
| Facility | | $3.16 | $22.39 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $6.61
| Professional | | $2.75 | $3.80 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $6.61
| Facility | | $3.16 | $3.16 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.80
| Professional | | $3.16 | $3.16 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.57 / $9.33
| Facility | | $3.09 | $4.57 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.98 / $79.43
| Professional | | $3.16 | $3.98 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $9.55 / $13.18
| Facility | | $4.79 | $9.55 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.24 / $4.07
| Professional | | $2.40 | $3.24 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.80 / $5.13
| Facility | | $2.00 | $3.80 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.57 / $5.13
| Professional | | $1.91 | $2.57 | $5.13 |