- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $776.25 / $4,897.79
| Facility | | $190.55 | $776.25 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $67.61 / $707.95
| Professional | | $2.95 | $67.61 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.96
| Professional | | $10.00 | $10.00 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $3.02 / $6.61
| Facility | | $0.60 | $3.02 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.18 / $2.29
| Professional | | $0.11 | $0.18 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.16 / $0.28
| Facility | | $0.15 | $0.16 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.11 / $0.11
| Professional | | $0.11 | $0.11 | $0.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.19 / $2.69
| Facility | | $0.11 | $0.19 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $30.20
| Professional | | $5.13 | $5.13 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.20
| Facility | | $0.20 | $0.20 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.12 / $0.13
| Professional | | $0.10 | $0.12 | $0.13 |