- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $31.62 / $95.50
| Facility | | $2.57 | $31.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.24 / $7.94
| Professional | | $1.78 | $2.24 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.62 / $27.54
| Professional | | $1.00 | $1.62 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $7.59
| Facility | | $5.25 | $5.25 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.55 / $5.01
| Professional | | $1.55 | $1.55 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $4.68 / $10.72
| Facility | | $1.62 | $4.68 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.95 / $3.63
| Professional | | $1.17 | $1.95 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $4.57 / $5.25
| Professional | | $1.95 | $4.57 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.14 / $4.68
| Facility | | $1.91 | $2.14 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $4.27 / $4.79
| Professional | | $1.91 | $4.27 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $389.05 / $954.99
| Facility | | $380.19 | $389.05 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $2.34 / $4.17
| Facility | | $1.26 | $2.34 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $2.29 / $3.31
| Professional | | $1.41 | $2.29 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |