- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $5.37 / $12.88
| Facility | | $1.00 | $5.37 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.12 / $4.07
| Professional | | $1.00 | $1.12 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $9.12
| Facility | | $2.19 | $2.19 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.07 / $1.66
| Professional | | $1.07 | $1.07 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.23 / $15.14
| Professional | | $6.46 | $10.23 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $5.75 / $10.47
| Facility | | $2.19 | $5.75 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.55 / $3.89
| Professional | | $1.23 | $1.55 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.57 / $3.24
| Professional | | $2.19 | $2.57 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.63 / $4.27
| Professional | | $1.82 | $3.63 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $2.04
| Facility | | $1.95 | $1.95 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.40 / $4.57
| Professional | | $1.95 | $2.40 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.55 / $10,000.00
| Facility | | $1.95 | $3.55 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.72 / $10,000.00
| Professional | | $1.95 | $3.72 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $2.19 / $3.72
| Facility | | $0.91 | $2.19 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.82 / $3.02
| Professional | | $1.29 | $1.82 | $3.02 |