- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $11.75 / $19.50
| Facility | | $3.98 | $11.75 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $9.12
| Professional | | $3.02 | $3.98 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.46 / $100.00
| Facility | | $4.17 | $6.46 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.57 / $11.22
| Professional | | $2.75 | $4.57 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $16.60
| Facility | | $9.12 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $5.75
| Professional | | $4.27 | $4.27 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $7.24 / $17.38
| Facility | | $3.55 | $7.24 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $5.25 / $11.75
| Professional | | $2.82 | $5.25 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $36.31 / $7,079.46
| Facility | | $5.25 | $36.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $7.76
| Professional | | $6.46 | $6.46 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $12.59
| Professional | | $4.57 | $4.57 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.46 / $100.00
| Facility | | $4.17 | $6.46 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.57 / $11.22
| Professional | | $2.75 | $4.57 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $4.57 / $6.61
| Facility | | $2.29 | $4.57 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $11.48
| Professional | | $2.75 | $3.80 | $11.48 |