- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $81.28 / $870.96
| Facility | | $8.71 | $81.28 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $8.51 / $31.62
| Professional | | $2.00 | $8.51 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $4.57 / $5.50
| Professional | | $1.86 | $4.57 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $1,584.89 / $9,772.37
| Facility | | $9.33 | $1,584.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $8.91 / $9.33
| Professional | | $3.02 | $8.91 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.57 / $22.91
| Facility | | $1.74 | $2.57 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.02 / $8.13
| Professional | | $1.86 | $3.02 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $354.81 / $851.14
| Facility | | $16.22 | $354.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.62 / $7.41
| Professional | | $4.17 | $5.62 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.69 / $9.33
| Facility | | $1.82 | $2.69 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $3.02 / $5.01
| Professional | | $1.05 | $3.02 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $2.40 / $9.33
| Professional | | $1.20 | $2.40 | $9.33 |