- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $17.38 / $60.26
| Facility | | $2.88 | $17.38 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.09 / $4.27
| Professional | | $2.00 | $3.09 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.78 / $2.51
| Professional | | $1.74 | $1.78 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $12.30 / $21.38
| Facility | | $4.90 | $12.30 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.88 / $5.50
| Professional | | $1.95 | $2.88 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $5.25 / $31.62
| Facility | | $3.31 | $5.25 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.24 / $6.03
| Professional | | $2.51 | $3.24 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $3.55
| Facility | | $3.55 | $3.55 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $7.94 / $19.95
| Facility | | $4.17 | $7.94 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.82 / $6.03
| Professional | | $2.04 | $2.82 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.25 / $5.89
| Professional | | $3.16 | $5.25 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.98 / $46.77
| Facility | | $2.69 | $3.98 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.24 / $6.03
| Professional | | $2.00 | $3.24 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.02 / $3.02
| Professional | | $2.69 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.55 / $10.47
| Facility | | $2.88 | $3.55 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.75 / $6.03
| Professional | | $2.04 | $2.75 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $3.55 / $4.27
| Facility | | $1.62 | $3.55 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.95 / $3.98
| Professional | | $2.14 | $2.95 | $3.98 |