- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $123.03 / $275.42
| Facility | | $18.62 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $51.29
| Professional | | $14.45 | $17.38 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $13.49 / $46.77
| Professional | | $5.37 | $13.49 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $83.18
| Facility | | $42.66 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $17.78
| Professional | | $8.71 | $12.59 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $40.74 / $89.13
| Facility | | $13.49 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $29.51
| Professional | | $10.00 | $13.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $36.31 / $51.29
| Professional | | $16.22 | $36.31 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $16.98 / $38.02
| Facility | | $15.49 | $16.98 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $20.89
| Professional | | $15.49 | $18.62 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $1,288.25
| Facility | | $229.09 | $229.09 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $19.50 / $33.88
| Facility | | $9.77 | $19.50 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $13.49 / $26.92
| Professional | | $8.13 | $13.49 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $100.00
| Facility | | $91.20 | $91.20 | $100.00 |