- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $114.82 / $660.69
| Facility | | $23.44 | $114.82 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.00 / $33.88
| Professional | | $8.51 | $10.00 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $7.76 / $79.43
| Professional | | $6.76 | $7.76 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $27.54 / $43.65
| Facility | | $26.30 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $8.13 / $8.91
| Professional | | $5.62 | $8.13 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.30 / $56.23
| Facility | | $8.51 | $26.30 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $7.08 / $16.98
| Professional | | $5.89 | $7.08 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $18.20 / $31.62
| Professional | | $8.13 | $18.20 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $9.33 / $19.05
| Facility | | $8.13 | $9.33 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $7.24
| Professional | | $7.24 | $7.24 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,290.87 / $3,630.78
| Facility | | $2,187.76 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $13.80 / $18.62
| Facility | | $6.31 | $13.80 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $19.95
| Professional | | $5.62 | $7.08 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |