- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $25.70
| Professional | | $2.00 | $3.98 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.46
| Facility | | $0.46 | $0.46 | $0.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $5.89 / $16.22
| Professional | | $3.02 | $5.89 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.88 / $19.50
| Facility | | $9.55 | $12.88 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.61 / $25.70
| Professional | | $3.55 | $6.61 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $6.46
| Facility | | $4.79 | $4.79 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.57 / $7.59
| Professional | | $4.07 | $4.57 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $6.92
| Professional | | $5.75 | $5.75 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $5.75 / $9.77
| Professional | | $4.90 | $5.75 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $100.00
| Facility | | $79.43 | $85.11 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $4.79 / $8.13
| Facility | | $2.24 | $4.79 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.17 / $5.75
| Professional | | $4.07 | $4.17 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $13.18
| Professional | | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.75 / $5.89
| Professional | | $5.62 | $5.75 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $2.24 / $4.37
| Facility | | $0.28 | $2.24 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.72 / $8.32
| Professional | | $2.51 | $3.72 | $8.32 |