- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $23.44 / $190.55
| Facility | | $8.91 | $23.44 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.79 / $33.11
| Professional | | $3.98 | $4.79 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.90 / $7.24
| Facility | | $3.89 | $4.90 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.90 / $16.22
| Professional | | $4.79 | $4.90 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $8.91
| Facility | | $6.31 | $6.31 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.61 / $14.79
| Professional | | $5.13 | $6.61 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $6.17 / $8.32
| Facility | | $3.72 | $6.17 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $3.72
| Professional | | $3.55 | $3.55 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.79 / $14.13
| Professional | | $3.24 | $4.79 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $6.76 / $10.72
| Facility | | $3.72 | $6.76 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $7.76
| Professional | | $3.55 | $3.55 | $7.76 |
- 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
- $2.82 / $3.89 / $6.03
| Professional | | $2.82 | $3.89 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $12.59
| Professional | | $4.79 | $4.79 | $12.59 |