- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $10.23 / $25.70
| Facility | | $3.98 | $10.23 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.01
| Professional | | $3.02 | $3.02 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $18.20
| Facility | | $4.27 | $4.27 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $3.31
| Professional | | $2.14 | $2.14 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.42 / $30.20
| Professional | | $12.88 | $20.42 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $11.48 / $19.50
| Facility | | $4.37 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.09 / $6.17
| Professional | | $2.29 | $3.09 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.13 / $6.31
| Professional | | $4.27 | $5.13 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $8.32
| Professional | | $7.24 | $7.24 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.89 / $4.07
| Facility | | $3.80 | $3.89 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.31 / $9.12
| Professional | | $3.80 | $6.31 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $6.17 / $10,000.00
| Facility | | $3.39 | $6.17 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $6.17 / $10,000.00
| Professional | | $3.39 | $6.17 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $4.27 / $7.41
| Facility | | $1.82 | $4.27 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.57 / $4.47
| Professional | | $1.82 | $2.57 | $4.47 |