- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $38.90 / $63.10
| Facility | | $12.02 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $25.70
| Professional | | $10.00 | $12.02 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $5,011.87
| Facility | | $75.86 | $100.00 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $12.59
| Professional | | $11.22 | $11.22 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $21.88 / $48.98
| Facility | | $10.23 | $21.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $18.20 / $34.67
| Professional | | $8.51 | $18.20 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $14.45 / $20.89
| Professional | | $6.76 | $14.45 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Facility | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $25.12
| Professional | | $14.13 | $15.85 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $38.02 / $48.98
| Facility | | $12.02 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $18.20
| Professional | | $10.00 | $12.02 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $15.14 / $15.85
| Facility | | $14.45 | $15.14 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $20.42
| Professional | | $10.47 | $15.14 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.45 / $17.38
| Facility | | $8.32 | $14.45 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.72 / $25.12
| Professional | | $6.46 | $10.72 | $25.12 |