- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $40.74 / $199.53
| Facility | | $11.48 | $40.74 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.72 / $25.12
| Professional | | $8.91 | $10.72 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $8.32 / $22.91
| Professional | | $3.31 | $8.32 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.92 / $38.02
| Facility | | $26.30 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $8.51 / $10.96
| Professional | | $7.24 | $8.51 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $54.95
| Facility | | $8.32 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $18.62
| Professional | | $6.17 | $8.32 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $28.84 / $29.51
| Professional | | $10.00 | $28.84 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $10.47 / $23.44
| Facility | | $9.77 | $10.47 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $5.01
| Professional | | $4.47 | $4.47 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $100.00
| Facility | | $48.98 | $48.98 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $12.02 / $20.89
| Facility | | $6.31 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $16.98
| Professional | | $6.03 | $8.51 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |