- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $18.62 / $81.28
| Facility | | $6.92 | $18.62 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $13.80
| Professional | | $5.01 | $6.03 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $100.00
| Facility | | $6.31 | $9.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.92 / $16.98
| Professional | | $4.17 | $6.92 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $24.55
| Facility | | $13.80 | $17.38 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $8.91
| Professional | | $6.61 | $6.61 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.96 / $26.92
| Facility | | $5.50 | $10.96 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $8.32 / $18.20
| Professional | | $4.17 | $8.32 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $54.95 / $7,079.46
| Facility | | $7.94 | $54.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $12.02
| Professional | | $10.23 | $10.23 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $19.05
| Professional | | $6.92 | $6.92 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $100.00
| Facility | | $6.31 | $9.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.92 / $16.98
| Professional | | $4.17 | $6.92 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.92 / $10.47
| Facility | | $3.98 | $6.92 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.89 / $19.05
| Professional | | $4.17 | $5.89 | $19.05 |