- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.91
| Facility | | $1.00 | $1.00 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $302.00 / $1,995.26
| Professional | | $18.20 | $302.00 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $63.10
| Professional | | $56.23 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $14.79 / $85.11
| Facility | | $6.03 | $14.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.85
| Professional | | $0.46 | $0.46 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $1.07
| Facility | | $0.52 | $0.52 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.52
| Professional | | $0.52 | $0.52 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.79 / $1.55
| Professional | | $0.72 | $0.79 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.78 / $16.22
| Facility | | $0.65 | $0.78 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.91
| Professional | | $0.52 | $0.52 | $0.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.62 / $0.74
| Facility | | $0.56 | $0.62 | $0.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.65 / $0.69
| Professional | | $0.62 | $0.65 | $0.69 |