- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $93.33 / $407.38
| Facility | | $10.72 | $93.33 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.08 / $23.44
| Professional | | $5.75 | $7.08 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $5.37 / $17.38
| Professional | | $2.14 | $5.37 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $33.11 / $33.11
| Facility | | $17.38 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $16.22
| Professional | | $5.01 | $5.01 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $16.22 / $35.48
| Facility | | $5.37 | $16.22 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.17 / $11.75
| Professional | | $4.07 | $6.17 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.46 / $10.72
| Professional | | $3.98 | $6.46 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.17 / $15.14
| Facility | | $6.03 | $6.17 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $6.31
| Professional | | $5.62 | $5.62 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,630.27 / $2,951.21
| Facility | | $2,398.83 | $2,630.27 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $7.76 / $13.49
| Facility | | $3.89 | $7.76 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $5.50 / $11.22
| Professional | | $3.55 | $5.50 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |