- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $724.44 / $2,454.71
| Facility | | $323.59 | $724.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $380.19 / $1,122.02
| Professional | | $1.58 | $380.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $0.24
| Facility | | $0.23 | $0.23 | $0.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $0.23
| Professional | | $0.23 | $0.23 | $0.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.12
| Facility | | $1.10 | $1.10 | $1.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.31 / $1.02
| Facility | | $0.26 | $0.31 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $1.35
| Professional | | $0.23 | $0.23 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.28 / $0.79
| Facility | | $0.22 | $0.28 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.28
| Professional | | $0.25 | $0.25 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.89 / $0.89
| Facility | | $0.34 | $0.89 | $0.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.34 / $0.89
| Professional | | $0.32 | $0.34 | $0.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.48 / $1.74
| Facility | | $0.36 | $0.48 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $3.16 / $53,703.18
| Facility | | $0.34 | $3.16 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.33 / $0.54
| Facility | | $0.23 | $0.33 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.37 / $2.45
| Professional | | $0.33 | $0.37 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.68 / $0.95
| Facility | | $0.32 | $0.68 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.34 / $1.07
| Professional | | $0.32 | $0.34 | $1.07 |