- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $19.50 / $97.72
| Facility | | $6.76 | $19.50 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $15.14
| Professional | | $6.03 | $6.03 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $9.77
| Facility | | $6.92 | $6.92 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $6.92 / $5,011.87
| Facility | | $5.89 | $6.92 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $6.61
| Professional | | $6.61 | $6.61 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $28.84 / $30.90
| Facility | | $8.13 | $28.84 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.13
| Professional | | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.13
| Facility | | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $14.13
| Professional | | $12.30 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $12.02 / $35.48
| Facility | | $8.13 | $12.02 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $9.77
| Facility | | $6.92 | $6.92 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.71 / $16.98
| Facility | | $8.13 | $8.71 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $9.12
| Professional | | $6.03 | $6.03 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,398.83 / $3,019.95
| Facility | | $1,000.00 | $2,398.83 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.62 / $12.88
| Facility | | $5.01 | $5.62 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.62 / $12.88
| Professional | | $5.01 | $5.62 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $11.75
| Professional | | $6.46 | $6.46 | $11.75 |