- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $11.22 / $22.39
| Facility | | $3.02 | $11.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.98
| Professional | | $3.02 | $3.02 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $21.88
| Facility | | $5.13 | $5.13 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $3.47
| Professional | | $2.04 | $2.04 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $26.30
| Professional | | $11.22 | $17.78 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $9.77 / $23.99
| Facility | | $5.25 | $9.77 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.09 / $7.24
| Professional | | $2.51 | $3.09 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.17 / $7.59
| Professional | | $5.13 | $6.17 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.31 / $7.41
| Professional | | $3.09 | $6.31 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.72 / $4.37
| Facility | | $3.24 | $3.72 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $10.72
| Professional | | $3.24 | $3.24 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $6.46 / $10,000.00
| Facility | | $3.72 | $6.46 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $6.61 / $10,000.00
| Professional | | $3.72 | $6.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $5.13 / $6.46
| Facility | | $2.14 | $5.13 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.40 / $5.13
| Professional | | $2.14 | $2.40 | $5.13 |