- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $44.67 / $95.50
| Facility | | $5.50 | $44.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.55 / $11.22
| Professional | | $3.02 | $3.55 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $2.75 / $12.30
| Professional | | $1.17 | $2.75 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $13.49
| Facility | | $9.55 | $9.55 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $8.32
| Professional | | $2.82 | $2.82 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $8.71 / $19.50
| Facility | | $2.95 | $8.71 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.09 / $6.46
| Professional | | $2.00 | $3.09 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $7.59 / $7.94
| Professional | | $3.24 | $7.59 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.55 / $7.76
| Facility | | $3.24 | $3.55 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $4.27 / $4.79
| Professional | | $3.16 | $4.27 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,995.26 / $3,235.94
| Facility | | $1,819.70 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.27 / $6.92
| Facility | | $2.09 | $4.27 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.89 / $5.62
| Professional | | $2.57 | $3.89 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |