- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $275.42 / $933.25
| Facility | | $87.10 | $275.42 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $109.65 / $234.42
| Professional | | $50.12 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.35
| Facility | | $0.25 | $0.25 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.26 / $5,011.87
| Facility | | $0.22 | $0.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.24 / $0.24
| Professional | | $0.24 | $0.24 | $0.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.78 / $0.83
| Facility | | $0.22 | $0.78 | $0.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.22 / $0.22
| Professional | | $0.22 | $0.22 | $0.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.22 / $0.22
| Facility | | $0.22 | $0.22 | $0.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.38 / $0.38
| Professional | | $0.33 | $0.38 | $0.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $2.45 / $3.89
| Facility | | $0.63 | $2.45 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.35
| Facility | | $0.25 | $0.25 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.43 / $5.50
| Facility | | $0.06 | $0.43 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $426.58
| Facility | | $138.04 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.26 / $0.45
| Facility | | $0.18 | $0.26 | $0.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.22 / $0.32
| Professional | | $0.13 | $0.22 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.83
| Professional | | $0.60 | $0.60 | $0.83 |