- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $41.69 / $107.15
| Facility | | $13.18 | $41.69 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $26.92
| Professional | | $10.00 | $12.88 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $5,011.87
| Facility | | $81.28 | $109.65 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $13.49
| Professional | | $12.02 | $12.02 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $23.44 / $52.48
| Facility | | $11.22 | $23.44 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.95 / $38.02
| Professional | | $9.12 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $15.49 / $22.39
| Professional | | $7.24 | $15.49 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Facility | | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $17.38 / $26.92
| Professional | | $15.14 | $17.38 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $100.00
| Facility | | $27.54 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $11.75
| Professional | | $9.33 | $9.33 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.44 / $46.77
| Facility | | $12.59 | $23.44 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $19.05
| Professional | | $10.96 | $12.88 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $33.88
| Facility | | $15.49 | $16.60 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.60 / $46.77
| Professional | | $8.13 | $16.60 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $15.49 / $18.62
| Facility | | $9.12 | $15.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.23 / $26.92
| Professional | | $6.46 | $10.23 | $26.92 |