- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $95.50 / $398.11
| Facility | | $38.90 | $95.50 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $154.88 / $380.19
| Professional | | $12.02 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $7.94 / $18.20
| Professional | | $0.11 | $7.94 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.40 / $5,011.87
| Facility | | $0.34 | $0.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.40 / $0.40
| Professional | | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.32 / $0.34
| Facility | | $0.09 | $0.32 | $0.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.09
| Professional | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.10 / $0.10
| Professional | | $0.09 | $0.10 | $0.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.09
| Facility | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.14 / $0.21
| Professional | | $0.10 | $0.14 | $0.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.44 / $0.56 / $5.75
| Facility | | $0.44 | $0.56 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $1.26 / $3.98
| Facility | | $0.24 | $1.26 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.00
| Professional | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $562.34 / $794.33
| Facility | | $512.86 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.18 / $0.60
| Professional | | $0.10 | $0.18 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.13 / $0.18
| Facility | | $0.10 | $0.13 | $0.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.13 / $0.66
| Professional | | $0.10 | $0.13 | $0.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.10 / $0.20
| Professional | | $0.10 | $0.10 | $0.20 |