- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $13.49 / $14.13
| Facility | | $3.80 | $13.49 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $5.37
| Professional | | $2.00 | $3.02 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.22 / $16.22
| Facility | | $9.12 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.80 / $4.79
| Professional | | $3.24 | $3.80 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.71 / $19.50
| Facility | | $2.95 | $8.71 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.95 / $6.61
| Professional | | $2.19 | $2.95 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $7.41 / $8.32
| Professional | | $3.55 | $7.41 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.89 / $7.41
| Facility | | $3.39 | $3.89 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.62 / $5.62
| Professional | | $3.47 | $5.62 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $5.62 / $8.13
| Facility | | $2.24 | $5.62 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.80 / $6.03
| Professional | | $2.57 | $3.80 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |