- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $239.88 / $794.33
| Facility | | $15.85 | $239.88 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.76 / $15.85
| Professional | | $5.13 | $6.76 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.25 / $8.51
| Professional | | $3.80 | $5.25 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $19.95 / $44.67
| Facility | | $5.50 | $19.95 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.62 / $7.59
| Professional | | $5.01 | $5.62 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $11.75 / $416.87
| Facility | | $6.31 | $11.75 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.91 / $14.45
| Professional | | $5.89 | $8.91 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $8.51
| Facility | | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $17.78 / $42.66
| Facility | | $9.55 | $17.78 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $9.33 / $15.14
| Professional | | $5.25 | $9.33 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.72 / $15.49
| Professional | | $7.08 | $10.72 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $128.82 / $645.65
| Facility | | $7.59 | $128.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.24 / $16.98
| Professional | | $5.01 | $7.24 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.08 / $7.08
| Professional | | $6.31 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $12,589.25
| Facility | | $4,073.80 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $24.55
| Facility | | $6.76 | $8.51 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $9.12 / $14.45
| Professional | | $5.25 | $9.12 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $8.51 / $10.23
| Facility | | $3.55 | $8.51 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $5.01 / $11.75
| Professional | | $3.55 | $5.01 | $11.75 |