- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $87.10 / $204.17
| Facility | | $15.85 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.00 / $21.38
| Professional | | $8.91 | $10.00 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $52.48
| Facility | | $12.30 | $12.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $9.55
| Professional | | $6.03 | $6.03 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $87.10
| Professional | | $36.31 | $57.54 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $29.51 / $56.23
| Facility | | $12.59 | $29.51 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.12 / $21.38
| Professional | | $6.76 | $9.12 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.79 / $18.20
| Professional | | $12.30 | $14.79 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $20.89 / $23.99
| Professional | | $10.23 | $20.89 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $11.22 / $11.75
| Facility | | $10.47 | $11.22 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $25.70
| Professional | | $10.47 | $19.50 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $20.89 / $10,000.00
| Facility | | $10.96 | $20.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $20.89 / $10,000.00
| Professional | | $10.96 | $20.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $12.30 / $21.38
| Facility | | $5.13 | $12.30 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.41 / $12.88
| Professional | | $5.13 | $7.41 | $12.88 |