- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $45.71 / $112.20
| Facility | | $6.31 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $16.60
| Professional | | $5.01 | $6.03 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.57 / $4.57
| Professional | | $2.51 | $4.57 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $24.55
| Facility | | $17.38 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $12.02
| Professional | | $5.01 | $6.03 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $13.49 / $30.20
| Facility | | $4.57 | $13.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.57 / $9.77
| Professional | | $3.39 | $4.57 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $9.77 / $12.88
| Professional | | $5.50 | $9.77 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.75 / $11.22
| Facility | | $5.25 | $5.75 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $8.32 / $9.12
| Professional | | $5.37 | $8.32 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $363.08
| Facility | | $239.88 | $239.88 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $6.61 / $11.48
| Facility | | $3.47 | $6.61 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.07 / $9.33
| Professional | | $3.31 | $4.07 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |