- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $16.98 / $407.38
| Facility | | $6.03 | $16.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $10.00
| Professional | | $3.98 | $3.98 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $28.84 / $1,548.82
| Facility | | $10.47 | $28.84 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $5,011.87
| Facility | | $30.20 | $39.81 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $5.62
| Professional | | $4.47 | $4.47 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $8.71 / $19.05
| Facility | | $4.07 | $8.71 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $7.24 / $13.80
| Professional | | $3.39 | $7.24 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.39 / $8.32
| Professional | | $2.69 | $3.39 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $5.75
| Facility | | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.46 / $10.00
| Professional | | $5.75 | $6.46 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $169.82 / $389.05
| Facility | | $32.36 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $26.92 / $245.47
| Facility | | $12.02 | $26.92 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $8.71 / $20.42
| Facility | | $4.57 | $8.71 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $8.71
| Professional | | $3.98 | $3.98 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.31 / $9.12
| Facility | | $5.75 | $6.31 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.31 / $9.33
| Professional | | $5.75 | $6.31 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $380.19 / $575.44
| Facility | | $3.16 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.89 / $10.00
| Professional | | $2.57 | $3.89 | $10.00 |