- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $75.86 / $316.23
| Facility | | $5.62 | $75.86 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.75 / $7.94
| Professional | | $2.00 | $2.75 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.91 / $3.16
| Professional | | $1.45 | $1.91 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $8.13 / $17.38
| Facility | | $2.04 | $8.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.24 / $5.50
| Professional | | $2.04 | $2.24 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $5.13 / $60.26
| Facility | | $2.82 | $5.13 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.16 / $5.37
| Professional | | $2.24 | $3.16 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.16
| Facility | | $3.16 | $3.16 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $6.92 / $16.60
| Facility | | $3.72 | $6.92 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.47 / $5.50
| Professional | | $2.04 | $3.47 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.17 / $6.46
| Professional | | $2.75 | $4.17 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $53.70 / $229.09
| Facility | | $2.75 | $53.70 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.82 / $7.59
| Professional | | $1.91 | $2.82 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.63 / $2.63
| Professional | | $2.34 | $2.63 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.16 / $9.77
| Facility | | $2.51 | $3.16 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.47 / $5.50
| Professional | | $2.04 | $3.47 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $3.16 / $3.80
| Facility | | $1.32 | $3.16 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.63 / $4.47
| Professional | | $1.91 | $2.63 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.62 / $3.16
| Professional | | $1.23 | $1.62 | $3.16 |