- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $25.70 / $95.50
| Facility | | $5.01 | $25.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.80 / $4.68
| Professional | | $3.02 | $3.80 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $19.95
| Facility | | $4.68 | $4.68 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $3.55
| Professional | | $2.14 | $2.14 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.42 / $30.20
| Professional | | $12.88 | $20.42 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $11.22 / $20.89
| Facility | | $4.79 | $11.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.24 / $7.24
| Professional | | $2.29 | $3.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.62 / $7.08
| Professional | | $4.68 | $5.62 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $7.24 / $8.32
| Professional | | $3.55 | $7.24 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.89 / $4.17
| Facility | | $3.72 | $3.89 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.17 / $10.00
| Professional | | $3.72 | $4.17 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.41 / $10,000.00
| Facility | | $3.80 | $7.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.59 / $10,000.00
| Professional | | $3.80 | $7.59 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.68 / $7.41
| Facility | | $2.00 | $4.68 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.63 / $4.68
| Professional | | $2.00 | $2.63 | $4.68 |