- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $14.45 / $912.01
| Facility | | $2.00 | $14.45 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $7.08 / $25.12
| Professional | | $2.14 | $7.08 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.96 / $12.88
| Professional | | $8.32 | $10.96 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.98 / $10.00
| Facility | | $3.16 | $3.98 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.27 / $15.49
| Professional | | $3.63 | $4.27 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.59 / $27.54
| Professional | | $9.12 | $12.59 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $5.13
| Professional | | $5.13 | $5.13 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.02 / $14.79
| Professional | | $10.96 | $12.02 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $13.80 / $39.81
| Professional | | $9.77 | $13.80 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $54.95 / $81.28
| Professional | | $12.02 | $54.95 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Professional | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.96 / $15.14
| Facility | | $5.37 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $10.47
| Professional | | $5.13 | $5.13 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.79 / $22.91
| Professional | | $8.71 | $14.79 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.90 / $11.22
| Professional | | $4.07 | $4.90 | $11.22 |