- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $14.13 / $93.33
| Facility | | $4.90 | $14.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $1.48 / $3.98
| Professional | | $0.41 | $1.48 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $10.96
| Professional | | $8.91 | $8.91 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.36
| Facility | | $0.30 | $0.30 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.11 / $0.22
| Professional | | $0.11 | $0.11 | $0.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.19 / $0.26
| Facility | | $0.13 | $0.19 | $0.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.11 / $0.12
| Professional | | $0.11 | $0.11 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.13 / $0.16
| Facility | | $0.11 | $0.13 | $0.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,302.69 / $16,218.10 / $26,915.35
| Facility | | $12,302.69 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.15 / $0.17
| Facility | | $0.11 | $0.15 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.11 / $0.17
| Professional | | $0.09 | $0.11 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |