- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $52.48 / $93.33
| Facility | | $8.32 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.27 / $8.13
| Professional | | $3.02 | $4.27 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $19.95
| Facility | | $4.79 | $4.79 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $3.63
| Professional | | $2.34 | $2.34 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $22.39 / $33.11
| Professional | | $14.13 | $22.39 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $12.30 / $20.89
| Facility | | $4.79 | $12.30 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.63 / $8.13
| Professional | | $2.69 | $3.63 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.75 / $7.08
| Professional | | $4.79 | $5.75 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $7.94 / $9.33
| Professional | | $3.98 | $7.94 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.27 / $4.47
| Facility | | $4.07 | $4.27 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.27 / $10.00
| Professional | | $4.07 | $4.27 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.13 / $10,000.00
| Facility | | $4.27 | $8.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.13 / $10,000.00
| Professional | | $4.27 | $8.13 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.79 / $8.13
| Facility | | $2.00 | $4.79 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.82 / $5.25
| Professional | | $2.00 | $2.82 | $5.25 |