- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $7.59 / $20.42
| Facility | | $2.00 | $7.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $6.46
| Professional | | $2.00 | $2.00 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $14.45
| Facility | | $3.47 | $3.47 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $2.63
| Professional | | $1.70 | $1.70 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $16.22 / $23.99
| Professional | | $10.23 | $16.22 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $8.71 / $14.79
| Facility | | $3.47 | $8.71 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.57 / $6.03
| Professional | | $1.95 | $2.57 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.07 / $5.13
| Professional | | $3.47 | $4.07 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $5.75 / $6.76
| Professional | | $2.88 | $5.75 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.09 / $3.24
| Facility | | $3.02 | $3.09 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $5.50 / $7.24
| Professional | | $3.02 | $5.50 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $5.89 / $10,000.00
| Facility | | $3.09 | $5.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.03 / $10,000.00
| Professional | | $3.09 | $6.03 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $3.47 / $5.89
| Facility | | $1.45 | $3.47 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.04 / $3.63
| Professional | | $1.45 | $2.04 | $3.63 |