- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $30.20 / $91.20
| Facility | | $6.03 | $30.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $17.78
| Professional | | $2.00 | $3.02 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.66 / $3.24
| Professional | | $1.26 | $1.66 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $6.31 / $13.49
| Facility | | $2.29 | $6.31 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.40 / $10.00
| Professional | | $1.32 | $2.40 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $21.88 / $48.98
| Facility | | $6.17 | $21.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.09 / $8.91
| Professional | | $2.14 | $3.09 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $4.79 / $9.77
| Facility | | $2.04 | $4.79 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.95 / $5.89
| Professional | | $1.70 | $2.95 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.69 / $4.37
| Professional | | $2.40 | $2.69 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.69 / $6.17
| Professional | | $2.14 | $2.69 | $6.17 |
- 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
- $2.29 / $3.39 / $15.49
| Professional | | $2.29 | $3.39 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.62 / $3.24
| Professional | | $1.62 | $1.62 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.24 / $8.91
| Facility | | $2.24 | $3.24 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $2.69 / $5.89
| Professional | | $1.55 | $2.69 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $9.55
| Professional | | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.75 / $4.57
| Professional | | $2.14 | $2.75 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.86 / $2.69
| Facility | | $1.23 | $1.86 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.62 / $9.77
| Professional | | $1.12 | $1.62 | $9.77 |