- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.89 / $6.31
| Facility | | $3.24 | $3.89 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $4.47
| Professional | | $3.02 | $3.02 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $10.00
| Facility | | $8.32 | $8.32 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $4.37
| Professional | | $3.02 | $3.98 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.31 / $9.12
| Facility | | $4.57 | $6.31 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $4.57
| Professional | | $3.89 | $3.89 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.98 / $5.50
| Facility | | $3.55 | $3.98 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $12.30 / $13.80
| Facility | | $7.41 | $12.30 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.07 / $4.27
| Professional | | $3.80 | $4.07 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $100.00
| Facility | | $85.11 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |