- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $40.74 / $87.10
| Facility | | $2.00 | $40.74 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $22.91 / $30.20
| Professional | | $2.00 | $22.91 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $31.62 / $141.25
| Facility | | $12.88 | $31.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $30.20 / $72.44
| Professional | | $3.63 | $30.20 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $85.11
| Facility | | $47.86 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $28.18 / $29.51
| Professional | | $3.31 | $28.18 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $10.00 / $47.86
| Facility | | $2.82 | $10.00 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $29.51 / $52.48
| Professional | | $1.95 | $29.51 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $38.90 / $4,897.79
| Facility | | $5.62 | $38.90 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $51.29
| Professional | | $33.11 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $63.10
| Professional | | $30.20 | $30.20 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $31.62 / $141.25
| Facility | | $12.88 | $31.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $30.20 / $72.44
| Professional | | $3.63 | $30.20 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $13.49 / $30.20
| Facility | | $2.14 | $13.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $26.92 / $41.69
| Professional | | $2.14 | $26.92 | $41.69 |