- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $371.54 / $1,659.59
| Facility | | $89.13 | $371.54 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $134.90
| Professional | | $69.18 | $112.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.25 / $0.27
| Facility | | $0.20 | $0.25 | $0.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.27
| Professional | | $0.26 | $0.26 | $0.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.26
| Facility | | $0.26 | $0.26 | $0.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.23 / $0.28
| Professional | | $0.22 | $0.23 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.47 / $1.41 / $81.28
| Facility | | $0.47 | $1.41 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.59 / $0.65
| Professional | | $0.52 | $0.59 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $239.88 / $239.88
| Facility | | $208.93 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.28 / $0.65
| Facility | | $0.24 | $0.28 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.60 / $0.62
| Professional | | $0.56 | $0.60 | $0.62 |