- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $100.00 / $602.56
| Facility | | $11.48 | $100.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $7.76 / $21.38
| Professional | | $6.03 | $7.76 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $6.03 / $6.03
| Professional | | $2.34 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $37.15
| Facility | | $22.91 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.76 / $7.76
| Professional | | $6.46 | $7.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $18.20 / $38.90
| Facility | | $6.03 | $18.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.03 / $13.49
| Professional | | $4.57 | $6.03 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $16.60
| Professional | | $7.08 | $10.96 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $7.59 / $16.98
| Facility | | $6.92 | $7.59 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $12.02 / $13.49
| Professional | | $6.92 | $12.02 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,258.93 / $2,137.96
| Facility | | $1,148.15 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $8.71 / $15.14
| Facility | | $4.57 | $8.71 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $6.03 / $12.02
| Professional | | $4.27 | $6.03 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $100.00
| Facility | | $63.10 | $63.10 | $100.00 |