- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $42.66 / $95.50
| Facility | | $5.75 | $42.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.55 / $8.51
| Professional | | $2.00 | $3.55 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $16.60
| Facility | | $3.89 | $3.89 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $3.02
| Professional | | $1.95 | $1.95 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $18.62 / $27.54
| Professional | | $11.75 | $18.62 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $10.47 / $17.78
| Facility | | $3.98 | $10.47 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.47 / $7.76
| Professional | | $2.29 | $3.47 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.68 / $5.75
| Professional | | $3.89 | $4.68 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $6.61 / $7.59
| Professional | | $3.24 | $6.61 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.55 / $3.89
| Facility | | $3.39 | $3.55 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.47 / $8.32
| Professional | | $3.39 | $4.47 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.31 / $10,000.00
| Facility | | $3.55 | $6.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.17 / $10,000.00
| Professional | | $3.55 | $6.17 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $3.89 / $6.76
| Facility | | $1.66 | $3.89 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.31 / $5.50
| Professional | | $2.34 | $3.31 | $5.50 |