- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.02 / $467.74
| Facility | | $1.02 | $1.02 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $30.20 / $467.74
| Professional | | $6.17 | $30.20 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $107.15 / $173.78
| Facility | | $43.65 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $1.29 / $1.35
| Professional | | $0.56 | $1.29 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $1.23
| Facility | | $0.62 | $0.62 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Professional | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.65 / $1.26
| Professional | | $0.59 | $0.65 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.78 / $26.30
| Facility | | $0.35 | $0.78 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.74
| Professional | | $0.62 | $0.62 | $0.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $0.65
| Facility | | $0.50 | $0.50 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.39 / $0.50
| Professional | | $0.35 | $0.39 | $0.50 |