- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $812.83 / $6,025.60
| Facility | | $1.00 | $812.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.23
| Professional | | $1.00 | $1.00 | $1.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $2.19 / $3.72
| Facility | | $1.10 | $2.19 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.82
| Professional | | $1.10 | $1.10 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.78 / $2.69
| Professional | | $1.58 | $1.78 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $2.09 / $2.75
| Facility | | $1.55 | $2.09 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.12 / $2.69
| Professional | | $0.93 | $1.12 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $2.00
| Facility | | $1.12 | $1.12 | $2.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.62 / $2.29
| Facility | | $1.05 | $1.62 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.62 / $2.29
| Professional | | $1.05 | $1.62 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.38 / $2.45
| Facility | | $1.10 | $1.38 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.12 / $1.41
| Professional | | $1.10 | $1.12 | $1.41 |