- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $21.88 / $100.00
| Facility | | $5.13 | $21.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $12.88
| Professional | | $3.98 | $5.01 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.39 / $3.98
| Professional | | $2.82 | $3.39 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.62 / $6.61
| Facility | | $5.01 | $5.62 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.62 / $8.32
| Professional | | $4.68 | $5.62 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.92 / $14.45
| Facility | | $3.98 | $6.92 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.75 / $10.96
| Professional | | $2.95 | $5.75 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $24.55 / $53.70
| Facility | | $5.62 | $24.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $7.94
| Professional | | $3.39 | $3.39 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $3.39
| Professional | | $2.69 | $2.69 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $4.68 / $7.08
| Facility | | $2.40 | $4.68 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.31 / $7.94
| Professional | | $2.40 | $3.31 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $5.62
| Professional | | $3.39 | $3.39 | $5.62 |