- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $17.38 / $95.50
| Facility | | $3.63 | $17.38 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $13.49
| Professional | | $3.02 | $3.98 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $20.42
| Facility | | $4.90 | $4.90 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $3.72
| Professional | | $2.40 | $2.40 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $34.67
| Professional | | $14.45 | $22.91 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $12.59 / $22.39
| Facility | | $5.01 | $12.59 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.55 / $8.13
| Professional | | $2.69 | $3.55 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $5.89 / $7.24
| Professional | | $4.90 | $5.89 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $8.13 / $9.55
| Professional | | $4.07 | $8.13 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.47 / $4.90
| Facility | | $4.17 | $4.47 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $9.77 / $10.23
| Professional | | $4.17 | $9.77 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $8.13 / $10,000.00
| Facility | | $4.37 | $8.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $8.32 / $10,000.00
| Professional | | $4.37 | $8.32 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $4.90 / $8.32
| Facility | | $2.04 | $4.90 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.95 / $5.13
| Professional | | $2.04 | $2.95 | $5.13 |