- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $100.00 / $891.25
| Facility | | $9.77 | $100.00 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $56.23 / $177.83
| Professional | | $3.98 | $56.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $22.39
| Facility | | $5.25 | $5.25 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $3.98
| Professional | | $2.57 | $2.57 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $24.55 / $37.15
| Professional | | $15.49 | $24.55 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $13.49 / $23.99
| Facility | | $5.37 | $13.49 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.80 / $7.59
| Professional | | $2.82 | $3.80 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.31 / $7.76
| Professional | | $5.25 | $6.31 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.00 / $10.23
| Professional | | $8.71 | $10.00 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $5.37
| Facility | | $4.57 | $4.57 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.89 / $10.96
| Professional | | $5.37 | $5.89 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $7.94 / $10,000.00
| Facility | | $4.68 | $7.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $7.94 / $10,000.00
| Professional | | $4.68 | $7.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $5.25 / $8.91
| Facility | | $2.19 | $5.25 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.16 / $5.50
| Professional | | $2.19 | $3.16 | $5.50 |