- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $117.49 / $2,290.87
| Facility | | $2.00 | $117.49 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $21.88 / $89.13
| Professional | | $3.31 | $21.88 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.40 / $4.17
| Facility | | $2.04 | $2.40 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $6.76 / $14.45
| Professional | | $2.04 | $6.76 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $7.41 / $19.95
| Professional | | $4.68 | $7.41 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $9.77 / $23.44
| Facility | | $2.82 | $9.77 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $12.30 / $186.21
| Professional | | $5.25 | $12.30 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.37 / $13.80
| Professional | | $4.68 | $5.37 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $12.30
| Professional | | $4.37 | $4.37 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $9.33 / $12.88
| Professional | | $3.31 | $9.33 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $6.03 / $16.60
| Professional | | $2.63 | $6.03 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.37 / $14.45
| Professional | | $3.63 | $4.37 | $14.45 |