- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $63.10 / $263.03
| Facility | | $13.80 | $63.10 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $54.95
| Professional | | $6.03 | $8.91 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.13 / $13.49
| Professional | | $4.17 | $5.13 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $19.50 / $41.69
| Facility | | $4.79 | $19.50 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $7.41 / $23.99
| Professional | | $4.17 | $7.41 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $60.26 / $134.90
| Facility | | $19.50 | $60.26 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.55 / $27.54
| Professional | | $6.76 | $9.55 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $14.79 / $30.90
| Facility | | $6.46 | $14.79 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $9.55 / $19.05
| Professional | | $5.01 | $9.55 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.32 / $13.49
| Professional | | $7.41 | $8.32 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $19.50
| Professional | | $6.76 | $8.32 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $100.00
| Facility | | $72.44 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $10.00
| Professional | | $5.01 | $5.01 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.00 / $26.30
| Facility | | $6.92 | $10.00 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.76 / $21.38
| Professional | | $5.01 | $7.76 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $14.45
| Professional | | $6.76 | $8.51 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.75 / $8.32
| Facility | | $3.80 | $5.75 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $5.01 / $18.20
| Professional | | $3.55 | $5.01 | $18.20 |