- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $50.12 / $275.42
| Facility | | $8.51 | $50.12 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $15.85
| Professional | | $6.03 | $6.03 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $9.55
| Professional | | $6.92 | $6.92 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $19.50 / $45.71
| Facility | | $10.72 | $19.50 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $25.12 / $72.44
| Facility | | $5.62 | $25.12 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $19.95 / $54.95
| Facility | | $8.13 | $19.95 | $54.95 |
- 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
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $36.31 / $173.78
| Facility | | $6.46 | $36.31 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.46 / $16.22
| Professional | | $6.03 | $6.46 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $14.13
| Professional | | $9.33 | $9.33 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,454.71 / $2,454.71
| Facility | | $1,698.24 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $25.70
| Facility | | $6.46 | $9.33 | $25.70 |
- 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
- $15.14 / $20.42 / $20.42
| Facility | | $15.14 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $12.30
| Professional | | $6.46 | $6.46 | $12.30 |