- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $19.95 / $251.19
| Facility | | $5.01 | $19.95 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $6.03
| Professional | | $3.98 | $3.98 | $6.03 |
- 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
- $2.82 / $2.82 / $4.47
| Professional | | $2.82 | $2.82 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $40.74
| Professional | | $16.98 | $26.92 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $14.45 / $26.92
| Facility | | $5.89 | $14.45 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.27 / $9.77
| Professional | | $3.24 | $4.27 | $9.77 |
- 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
- $4.79 / $9.77 / $11.22
| Professional | | $4.79 | $9.77 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $6.03
| Facility | | $5.25 | $5.25 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $12.02 / $14.13
| Professional | | $6.03 | $12.02 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.77 / $10,000.00
| Facility | | $5.13 | $9.77 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.77 / $10,000.00
| Professional | | $5.13 | $9.77 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $5.75 / $10.00
| Facility | | $2.40 | $5.75 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.47 / $6.31
| Professional | | $2.40 | $3.47 | $6.31 |