- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $24.55 / $45.71
| Facility | | $5.62 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.04 / $18.20
| Professional | | $2.00 | $2.04 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.72 / $5.75
| Facility | | $2.34 | $3.72 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.09 / $30.90
| Professional | | $2.09 | $2.09 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.98 / $5.13
| Facility | | $2.51 | $3.98 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $6.61
| Professional | | $2.14 | $2.14 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $7.24 / $30.20
| Facility | | $2.04 | $7.24 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $3.02
| Professional | | $0.60 | $0.60 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.14 / $2.29
| Facility | | $2.04 | $2.14 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.04 / $5.62
| Professional | | $1.32 | $2.04 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | | $2,344.23 | $2,344.23 | $2,344.23 |