- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $14.45 / $93.33
| Facility | | $3.98 | $14.45 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.57 / $5.75
| Professional | | $3.98 | $4.57 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $24.55
| Facility | | $5.75 | $5.75 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $4.27
| Professional | | $2.57 | $2.57 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $24.55 / $36.31
| Professional | | $15.49 | $24.55 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $13.49 / $26.92
| Facility | | $5.89 | $13.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.80 / $8.91
| Professional | | $2.88 | $3.80 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.92 / $8.51
| Professional | | $5.75 | $6.92 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.71 / $10.00
| Professional | | $4.27 | $8.71 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.68 / $5.01
| Facility | | $4.47 | $4.68 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.92 / $12.02
| Professional | | $4.47 | $6.92 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $8.32 / $10,000.00
| Facility | | $4.57 | $8.32 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $8.32 / $10,000.00
| Professional | | $4.57 | $8.32 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $5.75 / $8.91
| Facility | | $2.45 | $5.75 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.16 / $5.37
| Professional | | $2.45 | $3.16 | $5.37 |