- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $61.66 / $125.89
| Facility | | $8.71 | $61.66 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.47 / $27.54
| Professional | | $5.01 | $10.47 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $3.39
| Professional | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $23.44
| Facility | | $6.76 | $6.76 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.03 / $17.38
| Professional | | $3.31 | $6.03 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $13.49 / $15.14
| Facility | | $12.59 | $13.49 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $38.02
| Facility | | $8.91 | $12.59 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $6.46 / $23.44
| Professional | | $3.63 | $6.46 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $25.70 / $100.00
| Facility | | $7.08 | $25.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.98 / $8.13
| Professional | | $2.82 | $3.98 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $6.76 / $8.32
| Facility | | $3.02 | $6.76 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.98 / $8.91
| Professional | | $2.82 | $3.98 | $8.91 |