- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $21.38 / $107.15
| Facility | | $1.55 | $21.38 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.51 / $2.04
| Professional | | $1.00 | $1.51 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $1.07 / $1.23
| Facility | | $0.91 | $1.07 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.17 / $1.23
| Professional | | $1.15 | $1.17 | $1.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $1.74
| Facility | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.10 / $1.35
| Professional | | $0.95 | $1.10 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $26.30 / $74.13
| Facility | | $6.46 | $26.30 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.12 / $1.35
| Professional | | $1.00 | $1.12 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.35 / $1.35
| Professional | | $1.35 | $1.35 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,677.35 / $5,248.07
| Facility | | $4,466.84 | $4,677.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.38 / $3.02
| Facility | | $0.95 | $1.38 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.07 / $1.62
| Professional | | $1.02 | $1.07 | $1.62 |