- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $29.51 / $630.96
| Facility | | $8.91 | $29.51 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.01 / $41.69
| Professional | | $3.16 | $5.01 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $14.79 / $31.62
| Facility | | $2.95 | $14.79 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.27 / $10.72
| Professional | | $2.51 | $4.27 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $40.74 / $100.00
| Facility | | $15.85 | $40.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.37 / $14.79
| Professional | | $3.02 | $4.37 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $11.22 / $21.38
| Facility | | $4.27 | $11.22 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.79 / $12.30
| Professional | | $2.75 | $4.79 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.31 / $10.23
| Professional | | $3.31 | $6.31 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.31 / $16.98
| Professional | | $5.13 | $6.31 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $6.31
| Professional | | $3.16 | $3.16 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.46 / $16.60
| Facility | | $3.16 | $6.46 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.17 / $12.59
| Professional | | $2.75 | $4.17 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.57 / $6.31
| Professional | | $3.31 | $4.57 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.37 / $912.01
| Facility | | $2.88 | $4.37 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.80 / $12.02
| Professional | | $2.24 | $3.80 | $12.02 |