- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $63.10 / $154.88
| Facility | | $9.77 | $63.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.71 / $26.92
| Professional | | $7.08 | $8.71 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $6.76 / $19.50
| Professional | | $2.69 | $6.76 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $41.69
| Facility | | $21.38 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $20.42
| Professional | | $6.31 | $6.31 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $20.42 / $44.67
| Facility | | $6.76 | $20.42 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.76 / $15.14
| Professional | | $5.01 | $6.76 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $13.18 / $13.49
| Professional | | $8.13 | $13.18 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.32 / $19.05
| Facility | | $7.59 | $8.32 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $11.48
| Professional | | $7.76 | $10.47 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,000.00 / $1,000.00
| Facility | | $501.19 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.77 / $16.98
| Facility | | $5.13 | $9.77 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.76 / $13.49
| Professional | | $4.90 | $6.76 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |