- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $89.13 / $776.25
| Facility | | $17.38 | $89.13 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $85.11 / $144.54
| Professional | | $22.91 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.32 / $186.21
| Facility | | $0.26 | $0.32 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.31 / $0.31
| Professional | | $0.28 | $0.31 | $0.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.32 / $0.41
| Professional | | $0.26 | $0.32 | $0.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $2.69 / $7.24
| Facility | | $0.34 | $2.69 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.71
| Professional | | $0.26 | $0.26 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.32 / $0.32
| Professional | | $0.30 | $0.32 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.66 / $0.66
| Professional | | $0.30 | $0.66 | $0.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,071.52 / $1,096.48
| Facility | | $912.01 | $1,071.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.32 / $0.69
| Facility | | $0.26 | $0.32 | $0.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.28 / $0.71
| Professional | | $0.26 | $0.28 | $0.71 |