- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $61.66 / $100.00
| Facility | | $7.76 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.25 / $16.22
| Professional | | $3.98 | $5.25 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $4.17 / $26.92
| Professional | | $1.66 | $4.17 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.70 / $25.70
| Facility | | $13.49 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.89 / $5.50
| Professional | | $3.63 | $3.89 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $12.88 / $27.54
| Facility | | $4.17 | $12.88 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.27 / $9.33
| Professional | | $3.02 | $4.27 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.48 / $16.60
| Professional | | $5.01 | $11.48 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.25 / $11.75
| Facility | | $4.79 | $5.25 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.13 / $8.91
| Professional | | $4.79 | $8.13 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,187.76 / $3,630.78
| Facility | | $2,041.74 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.03 / $10.47
| Facility | | $3.16 | $6.03 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.17 / $8.32
| Professional | | $3.02 | $4.17 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |