- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $407.38 / $912.01
| Facility | | $1.35 | $407.38 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $380.19 / $4,168.69
| Professional | | $2.09 | $380.19 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $1.15
| Professional | | $0.56 | $0.56 | $1.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.55 / $0.65 / $0.65
| Professional | | $0.55 | $0.65 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $1.05 / $1.32
| Facility | | $0.56 | $1.05 | $1.32 |
- 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
- $0.47 / $0.56 / $6.76
| Professional | | $0.47 | $0.56 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $27.54
| Professional | | $18.62 | $18.62 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.87 / $7.24
| Facility | | $0.65 | $0.87 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.09 / $2.09
| Professional | | $2.00 | $2.09 | $2.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.72 / $2.29
| Facility | | $0.52 | $0.72 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.72 / $2.29
| Professional | | $0.52 | $0.72 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.32
| Facility | | $1.00 | $1.00 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.69 / $5.62
| Professional | | $0.65 | $0.69 | $5.62 |