- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $28.84 / $104.71
| Facility | | $8.13 | $28.84 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $30.90
| Professional | | $3.02 | $3.98 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $10.96 / $23.44
| Facility | | $2.69 | $10.96 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $5.75 / $13.49
| Professional | | $2.34 | $5.75 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.90 / $79.43
| Facility | | $10.96 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.37 / $15.49
| Professional | | $3.80 | $5.37 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $8.32 / $17.38
| Facility | | $3.63 | $8.32 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.75 / $11.75
| Professional | | $2.88 | $5.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.68 / $7.59
| Professional | | $3.55 | $4.68 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.68 / $10.72
| Professional | | $3.80 | $4.68 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $5.62
| Professional | | $2.82 | $2.82 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $5.62 / $14.45
| Facility | | $3.89 | $5.62 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.37 / $11.75
| Professional | | $2.88 | $4.37 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.79 / $7.94
| Professional | | $3.80 | $4.79 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.24 / $5.62
| Facility | | $2.14 | $3.24 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.82 / $9.55
| Professional | | $2.00 | $2.82 | $9.55 |