- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $29.51 / $165.96
| Facility | | $6.31 | $29.51 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $26.92
| Professional | | $3.02 | $3.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $6.31
| Professional | | $2.40 | $2.40 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $9.33 / $19.95
| Facility | | $2.09 | $9.33 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.24 / $10.47
| Professional | | $1.82 | $3.24 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $30.20 / $61.66
| Facility | | $8.91 | $30.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $4.17 / $9.12
| Professional | | $2.95 | $4.17 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.08 / $14.45
| Facility | | $3.02 | $7.08 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $4.07 / $9.12
| Professional | | $2.14 | $4.07 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.46
| Professional | | $3.02 | $3.98 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.98 / $9.12
| Professional | | $3.24 | $3.98 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $4.79
| Professional | | $2.40 | $2.40 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.79 / $12.59
| Facility | | $3.24 | $4.79 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.47 / $9.12
| Professional | | $2.14 | $3.47 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Professional | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $5.13
| Professional | | $3.02 | $3.63 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.69 / $3.98
| Facility | | $1.82 | $2.69 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.19 / $7.76
| Professional | | $1.70 | $2.19 | $7.76 |