- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $64.57 / $117.49
| Facility | | $10.96 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $17.38
| Professional | | $5.01 | $6.03 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $4.68 / $13.18
| Professional | | $1.82 | $4.68 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $20.89 / $29.51
| Facility | | $11.22 | $20.89 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.37 / $6.03
| Professional | | $3.02 | $4.37 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $14.13 / $30.20
| Facility | | $4.68 | $14.13 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.68 / $10.47
| Professional | | $3.55 | $4.68 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $11.48 / $12.30
| Professional | | $5.62 | $11.48 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $5.89 / $13.18
| Facility | | $5.37 | $5.89 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $6.31 / $7.08
| Professional | | $5.37 | $6.31 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,148.15 / $1,174.90
| Facility | | $1,047.13 | $1,148.15 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.76 / $11.75
| Facility | | $3.55 | $6.76 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.68 / $9.55
| Professional | | $3.39 | $4.68 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |