- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $91.20 / $331.13
| Facility | | $19.05 | $91.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.91 / $29.51
| Professional | | $7.59 | $8.91 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $6.31
| Professional | | $6.17 | $6.17 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.23 / $12.02
| Facility | | $8.91 | $10.23 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $10.23 / $14.79
| Professional | | $8.51 | $10.23 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $12.30 / $26.30
| Facility | | $7.08 | $12.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.47 / $19.05
| Professional | | $5.37 | $10.47 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $43.65 / $95.50
| Facility | | $10.00 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $14.13
| Professional | | $6.17 | $6.17 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $4.90 / $6.17
| Professional | | $1.23 | $4.90 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.32 / $12.59
| Facility | | $4.27 | $8.32 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $6.03 / $14.13
| Professional | | $4.27 | $6.03 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $10.23
| Professional | | $6.17 | $6.17 | $10.23 |