- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $123.03 / $758.58
| Facility | | $10.96 | $123.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $35.48
| Professional | | $8.91 | $12.59 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $5.37 / $6.31
| Professional | | $4.68 | $5.37 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $53.70
| Facility | | $22.39 | $39.81 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.47 / $10.47
| Professional | | $8.91 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.92 / $57.54
| Facility | | $8.51 | $26.92 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $10.72 / $19.05
| Professional | | $5.89 | $10.72 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Professional | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.77 / $13.18
| Facility | | $9.12 | $9.77 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $11.22 / $12.88
| Professional | | $8.71 | $11.22 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $12.59 / $17.78
| Facility | | $6.31 | $12.59 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.41 / $14.79
| Professional | | $6.31 | $7.41 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |