- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $20.89 / $794.33
| Facility | | $3.80 | $20.89 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $25.12
| Professional | | $2.00 | $3.02 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $954.99 / $1,949.84
| Facility | | $562.34 | $954.99 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.47 / $3.80
| Professional | | $2.88 | $3.47 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $8.51 / $13.80
| Facility | | $3.98 | $8.51 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.17 / $6.17
| Professional | | $2.34 | $4.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.39 / $64.57
| Professional | | $2.45 | $3.39 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $7.94
| Facility | | $3.80 | $3.80 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.37 / $4.57
| Professional | | $3.80 | $4.37 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $6.17 / $12.88
| Facility | | $3.47 | $6.17 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $4.57
| Professional | | $3.47 | $3.47 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $954.99 / $1,949.84
| Facility | | $52.48 | $954.99 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.47 / $3.80
| Professional | | $2.88 | $3.47 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $1,230.27 / $2,041.74
| Facility | | $3.80 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.24 / $4.90
| Professional | | $1.62 | $2.24 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.00 / $6.92
| Professional | | $1.74 | $2.00 | $6.92 |