- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $57.54 / $549.54
| Facility | | $7.76 | $57.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $20.42
| Professional | | $3.02 | $3.98 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $14.13
| Facility | | $11.22 | $13.80 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $20.89
| Professional | | $2.57 | $2.57 | $20.89 |
- 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
- $14.45 / $16.98 / $26.92
| Facility | | $14.45 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.24 / $16.22
| Professional | | $5.75 | $7.24 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $11.22 / $41.69
| Facility | | $4.57 | $11.22 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.01 / $102.33
| Facility | | $4.17 | $5.01 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.37 / $11.75
| Professional | | $3.09 | $4.37 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $18.20 / $64.57
| Professional | | $2.57 | $18.20 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $14.79
| Facility | | $6.17 | $6.17 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $8.51 / $14.79
| Professional | | $3.89 | $8.51 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $13.49 / $63.10
| Professional | | $7.08 | $13.49 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $63.10
| Facility | | $50.12 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $5.01
| Professional | | $2.75 | $3.47 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $13.49
| Professional | | $10.96 | $10.96 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $26.30 / $31.62
| Professional | | $13.49 | $26.30 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $4.57 / $457.09
| Facility | | $2.57 | $4.57 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $4.27 / $11.75
| Professional | | $2.57 | $4.27 | $11.75 |