- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $91.20 / $199.53
| Facility | | $13.18 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $17.38
| Professional | | $7.08 | $8.32 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $6.61 / $50.12
| Professional | | $5.62 | $6.61 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $40.74 / $40.74
| Facility | | $20.89 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.51 / $8.51
| Professional | | $7.08 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $19.50 / $42.66
| Facility | | $6.61 | $19.50 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.46 / $14.45
| Professional | | $4.90 | $6.46 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $17.78 / $19.95
| Professional | | $7.76 | $17.78 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.13 / $18.62
| Facility | | $7.59 | $8.13 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.49 / $14.79
| Professional | | $7.59 | $13.49 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,951.21
| Facility | | $2,238.72 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $9.33 / $16.60
| Facility | | $5.01 | $9.33 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.61 / $13.18
| Professional | | $4.68 | $6.61 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $100.00
| Facility | | $69.18 | $69.18 | $100.00 |