- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $407.38 / $1,513.56
| Facility | | $3.98 | $407.38 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $11.22 / $117.49
| Professional | | $1.78 | $11.22 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.48 / $0.71 / $1.32
| Facility | | $0.48 | $0.71 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.48 / $0.48 / $1.48
| Professional | | $0.48 | $0.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.48 / $0.76 / $0.98
| Facility | | $0.48 | $0.76 | $0.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.41 / $0.89
| Professional | | $0.41 | $0.41 | $0.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $4.37
| Professional | | $4.37 | $4.37 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.72 / $5.50
| Facility | | $0.46 | $0.72 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $0.72
| Professional | | $0.72 | $0.72 | $0.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.91
| Professional | | $0.60 | $0.60 | $0.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.52 / $0.59
| Facility | | $0.46 | $0.52 | $0.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.46 / $0.51
| Professional | | $0.34 | $0.46 | $0.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |