- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $29.51 / $120.23
| Facility | | $1.41 | $29.51 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.95 / $2.51
| Professional | | $1.00 | $1.95 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.58 / $1.86
| Facility | | $1.35 | $1.58 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.55 / $1.58
| Professional | | $1.51 | $1.55 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.74 / $0.74
| Facility | | $0.74 | $0.74 | $0.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.66 / $1.78
| Professional | | $1.45 | $1.66 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $30.90 / $74.13
| Facility | | $11.48 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.58 / $1.86
| Professional | | $1.32 | $1.58 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $724.44
| Facility | | $616.60 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.91 / $4.17
| Facility | | $1.58 | $1.91 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.41 / $2.14
| Professional | | $1.35 | $1.41 | $2.14 |