- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $16.60 / $223.87
| Facility | | $6.46 | $16.60 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $41.69
| Professional | | $3.98 | $3.98 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $66.07 / $245.47
| Facility | | $12.02 | $66.07 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.77 / $10.47
| Professional | | $6.92 | $9.77 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $12.30 / $15.49
| Professional | | $4.68 | $12.30 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $16.98 / $446.68
| Facility | | $4.79 | $16.98 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $3.80 / $6.31
| Professional | | $1.35 | $3.80 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $13.18
| Professional | | $4.68 | $4.68 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $4.68
| Facility | | $4.68 | $4.68 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $7.59 / $537.03
| Facility | | $3.80 | $7.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.80 / $6.46
| Professional | | $2.69 | $3.80 | $6.46 |