- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $67.61 / $239.88
| Facility | | $6.61 | $67.61 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $6.92
| Professional | | $2.00 | $2.69 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $12.59
| Facility | | $3.02 | $3.02 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $2.29
| Professional | | $1.48 | $1.48 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $20.89
| Professional | | $8.91 | $15.14 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.94 / $13.49
| Facility | | $3.02 | $7.94 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.14 / $5.13
| Professional | | $1.58 | $2.14 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $4.47
| Professional | | $3.02 | $3.63 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $5.01 / $5.89
| Professional | | $2.45 | $5.01 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $4.79
| Facility | | $2.69 | $2.69 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.79 / $6.31
| Professional | | $3.02 | $4.79 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $5.13 / $10,000.00
| Facility | | $2.63 | $5.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $5.25 / $10,000.00
| Professional | | $2.63 | $5.25 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $3.02 / $6.17
| Facility | | $1.26 | $3.02 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.78 / $3.31
| Professional | | $1.26 | $1.78 | $3.31 |