- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $7.94 / $52.48
| Facility | | $2.00 | $7.94 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $15.14
| Professional | | $2.00 | $2.00 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $15.14
| Facility | | $3.55 | $3.55 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $2.75
| Professional | | $1.78 | $1.78 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $112.20
| Professional | | $47.86 | $75.86 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $16.22 / $57.54
| Facility | | $3.63 | $16.22 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.55 / $12.30
| Professional | | $1.95 | $3.55 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.27 / $5.25
| Professional | | $3.55 | $4.27 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $31.62
| Professional | | $22.91 | $22.91 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $3.55
| Facility | | $1.91 | $1.91 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $7.59
| Professional | | $2.88 | $2.88 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $9.12 / $10,000.00
| Facility | | $3.02 | $9.12 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $9.12 / $10,000.00
| Professional | | $3.02 | $9.12 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $3.55 / $27.54
| Facility | | $1.51 | $3.55 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $5.37 / $16.98
| Professional | | $1.51 | $5.37 | $16.98 |