- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $107.15 / $338.84
| Facility | | $13.80 | $107.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $9.33 / $25.12
| Professional | | $7.94 | $9.33 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.24 / $112.20
| Professional | | $6.17 | $7.24 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $33.11
| Facility | | $22.91 | $27.54 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.33 / $9.33
| Professional | | $7.76 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $21.38 / $46.77
| Facility | | $7.08 | $21.38 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $7.24 / $15.85
| Professional | | $5.37 | $7.24 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $19.95 / $30.20
| Professional | | $8.51 | $19.95 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $20.42
| Facility | | $8.32 | $9.33 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.79 / $16.22
| Professional | | $8.32 | $14.79 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $3,801.89
| Facility | | $1,778.28 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.47 / $18.20
| Facility | | $5.37 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $7.24 / $14.45
| Professional | | $5.13 | $7.24 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |