- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $91.20 / $1,000.00
| Facility | | $4.47 | $91.20 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $23.44
| Professional | | $1.00 | $1.00 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $93.33
| Professional | | $1.45 | $1.45 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.69 / $0.98
| Facility | | $0.56 | $0.69 | $0.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.95 / $1.12
| Professional | | $0.60 | $0.95 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.29 / $2.29
| Facility | | $1.26 | $1.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.93
| Professional | | $0.89 | $0.89 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $2.24 / $2.40
| Professional | | $0.50 | $2.24 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $1.05 / $1.86
| Facility | | $0.69 | $1.05 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.69 / $30.20
| Professional | | $2.45 | $2.69 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $1.78
| Facility | | $1.78 | $1.78 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.10 / $1.29
| Professional | | $0.89 | $1.10 | $1.29 |