- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $89.13 / $933.25
| Facility | | $8.91 | $89.13 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $8.91 / $44.67
| Professional | | $2.57 | $8.91 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.80 / $10.00
| Professional | | $1.86 | $3.80 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.76 / $9.33
| Professional | | $4.17 | $6.76 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $13.18 / $41.69
| Facility | | $2.04 | $13.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.88 / $7.41
| Professional | | $1.86 | $2.88 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $8.51
| Professional | | $3.02 | $3.02 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.88 / $9.77
| Facility | | $2.24 | $2.88 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $3.98
| Professional | | $1.95 | $1.95 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,949.84 / $7,943.28
| Facility | | $1,778.28 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.55 / $9.33
| Facility | | $1.82 | $3.55 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.82 / $4.47
| Professional | | $1.51 | $1.82 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |