- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $31.62 / $107.15
| Facility | | $5.89 | $31.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.37 / $8.91
| Professional | | $3.02 | $4.37 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.31 / $4.90
| Professional | | $2.40 | $3.31 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $13.80 / $27.54
| Facility | | $5.25 | $13.80 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.63 / $5.50
| Professional | | $2.69 | $3.63 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $7.41 / $23.44
| Facility | | $4.68 | $7.41 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.68 / $6.92
| Professional | | $3.47 | $4.68 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $4.90
| Facility | | $4.90 | $4.90 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.96 / $26.92
| Facility | | $5.75 | $10.96 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $9.77
| Professional | | $2.75 | $3.80 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $7.08 / $8.13
| Professional | | $4.37 | $7.08 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $8.91 / $93.33
| Facility | | $3.98 | $8.91 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $4.47 / $8.91
| Professional | | $2.95 | $4.47 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.17 / $4.17
| Professional | | $3.72 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $2,454.71
| Facility | | $1,348.96 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.90 / $14.45
| Facility | | $3.98 | $4.90 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $7.94
| Professional | | $2.75 | $3.80 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.90 / $5.89
| Facility | | $2.09 | $4.90 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.88 / $5.25
| Professional | | $2.09 | $2.88 | $5.25 |