- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $91.20 / $354.81
| Facility | | $10.00 | $91.20 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.51 / $26.30
| Professional | | $7.08 | $8.51 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $6.61 / $58.88
| Professional | | $5.62 | $6.61 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $30.20
| Facility | | $20.89 | $25.12 | $30.20 |
- 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 / $25.12 / $30.20
| Professional | | $7.76 | $25.12 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $8.51 / $18.62
| Facility | | $7.59 | $8.51 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $13.49
| Professional | | $7.59 | $12.02 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,047.13 / $2,137.96
| Facility | | $1,000.00 | $1,047.13 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $9.55 / $16.60
| Facility | | $5.01 | $9.55 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.61 / $13.18
| Professional | | $4.79 | $6.61 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $100.00
| Facility | | $79.43 | $79.43 | $100.00 |