- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $27.54 / $102.33
| Facility | | $5.89 | $27.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $10.23
| Professional | | $3.02 | $3.98 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $19.50
| Facility | | $4.57 | $4.57 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $3.55
| Professional | | $2.29 | $2.29 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $21.88 / $32.36
| Professional | | $13.49 | $21.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $11.75 / $20.89
| Facility | | $4.68 | $11.75 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.39 / $8.13
| Professional | | $2.51 | $3.39 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.50 / $6.76
| Professional | | $4.57 | $5.50 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.76 / $8.91
| Professional | | $3.80 | $7.76 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.17 / $4.57
| Facility | | $3.98 | $4.17 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.98 / $9.55
| Professional | | $3.72 | $3.98 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $7.59 / $10,000.00
| Facility | | $4.07 | $7.59 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $7.94 / $10,000.00
| Professional | | $4.07 | $7.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $4.57 / $7.94
| Facility | | $1.95 | $4.57 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.75 / $4.79
| Professional | | $1.95 | $2.75 | $4.79 |