- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $51.29 / $97.72
| Facility | | $4.90 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $5.01
| Professional | | $2.00 | $2.69 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.09 / $23.99
| Professional | | $2.00 | $2.09 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $9.33 / $11.22
| Facility | | $6.61 | $9.33 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.09 / $10.00
| Professional | | $1.78 | $2.09 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $6.03 / $13.49
| Facility | | $2.04 | $6.03 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.09 / $4.68
| Professional | | $1.51 | $2.09 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.13 / $14.13
| Professional | | $3.98 | $5.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.69 / $5.89
| Facility | | $2.40 | $2.69 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $16.98 / $19.05
| Professional | | $2.40 | $16.98 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,548.13 / $3,981.07
| Facility | | $3,388.44 | $3,548.13 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $4.27 / $29.51
| Facility | | $1.58 | $4.27 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.09 / $6.03
| Professional | | $1.51 | $2.09 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |