- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $69.18 / $295.12
| Facility | | $9.55 | $69.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $7.08 / $38.90
| Professional | | $4.17 | $7.08 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.72 / $7.24
| Professional | | $3.02 | $3.72 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $14.13 / $30.20
| Facility | | $3.47 | $14.13 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.25 / $16.98
| Professional | | $2.95 | $5.25 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $48.98 / $95.50
| Facility | | $13.80 | $48.98 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.92 / $19.50
| Professional | | $4.79 | $6.92 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $10.72 / $21.88
| Facility | | $4.57 | $10.72 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.08 / $13.49
| Professional | | $3.80 | $7.08 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $6.03 / $9.55
| Professional | | $5.37 | $6.03 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.03 / $13.49
| Professional | | $4.79 | $6.03 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $8.32 / $19.95
| Professional | | $5.25 | $8.32 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $7.24
| Professional | | $3.63 | $3.63 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.24 / $17.78
| Facility | | $5.01 | $7.24 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $6.03 / $13.49
| Professional | | $3.47 | $6.03 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.17 / $10.23
| Professional | | $4.79 | $6.17 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.17 / $6.03
| Facility | | $2.51 | $4.17 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.63 / $22.39
| Professional | | $2.51 | $3.63 | $22.39 |