- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $8.71 / $21.88
| Facility | | $2.00 | $8.71 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $3.16
| Professional | | $2.00 | $3.02 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $16.98
| Facility | | $3.98 | $3.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $3.02
| Professional | | $1.82 | $1.82 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $17.38 / $25.70
| Professional | | $10.72 | $17.38 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $9.12 / $17.78
| Facility | | $4.07 | $9.12 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.69 / $6.31
| Professional | | $1.95 | $2.69 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.79 / $5.89
| Professional | | $3.98 | $4.79 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $6.17 / $7.08
| Professional | | $3.02 | $6.17 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.31 / $3.55
| Facility | | $3.16 | $3.31 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $4.07 / $8.32
| Professional | | $3.16 | $4.07 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.50 / $10,000.00
| Facility | | $2.88 | $5.50 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.50 / $10,000.00
| Professional | | $2.88 | $5.50 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $3.98 / $6.31
| Facility | | $1.66 | $3.98 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $2.24 / $4.17
| Professional | | $1.66 | $2.24 | $4.17 |