- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $54.95 / $131.83
| Facility | | $5.62 | $54.95 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.90 / $14.79
| Professional | | $3.98 | $4.90 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.63 / $7.24
| Professional | | $2.19 | $3.63 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.22 / $22.91
| Facility | | $11.22 | $16.22 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $10.96
| Professional | | $3.63 | $3.63 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $10.72 / $23.44
| Facility | | $3.63 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $4.07 / $7.94
| Professional | | $2.69 | $4.07 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $12.59 / $14.45
| Professional | | $4.27 | $12.59 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.68 / $10.00
| Facility | | $4.17 | $4.68 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $8.32 / $9.12
| Professional | | $4.17 | $8.32 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,187.76
| Facility | | $1,995.26 | $1,995.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $5.13 / $9.12
| Facility | | $2.57 | $5.13 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $5.01 / $7.24
| Professional | | $3.09 | $5.01 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |