- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $26.30 / $51.29
| Facility | | $5.01 | $26.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.80 / $4.27
| Professional | | $3.02 | $3.80 | $4.27 |
- 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
- $2.09 / $2.09 / $3.24
| Professional | | $2.09 | $2.09 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $21.88 / $30.20
| Professional | | $12.59 | $21.88 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $10.96 / $19.50
| Facility | | $4.37 | $10.96 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.02 / $6.17
| Professional | | $2.29 | $3.02 | $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
- $7.08 / $7.08 / $8.32
| Professional | | $7.08 | $7.08 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $6.76
| Facility | | $3.89 | $3.89 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $8.91
| Professional | | $6.31 | $6.31 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.03 / $10,000.00
| Facility | | $3.55 | $6.03 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.03 / $10,000.00
| Professional | | $3.31 | $6.03 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $4.27 / $7.41
| Facility | | $1.78 | $4.27 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.55 / $6.03
| Professional | | $2.57 | $3.55 | $6.03 |