- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $6.92 / $5,370.32
| Facility | | $3.63 | $6.92 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $229.09
| Professional | | $3.02 | $3.63 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $13.49 / $363.08
| Facility | | $4.47 | $13.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.98 / $2,137.96
| Professional | | $3.63 | $3.98 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $7.94
| Facility | | $4.07 | $4.07 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.76 / $7.41
| Professional | | $4.07 | $6.76 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $7.24 / $17.38
| Facility | | $3.63 | $7.24 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $4.07
| Professional | | $4.07 | $4.07 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.62 / $5,888.44
| Facility | | $4.07 | $5.62 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $4.27
| Professional | | $4.07 | $4.07 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $151.36 / $446.68
| Facility | | $25.70 | $151.36 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $13.49 / $363.08
| Facility | | $4.47 | $13.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.98 / $2,137.96
| Professional | | $3.63 | $3.98 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $53.70 / $489.78
| Facility | | $8.32 | $53.70 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.07 / $8.13
| Facility | | $3.80 | $4.07 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.07 / $6.17
| Professional | | $3.63 | $4.07 | $6.17 |