- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $93.33 / $537.03
| Facility | | $6.61 | $93.33 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $4.47
| Professional | | $2.00 | $2.69 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $2.09
| Professional | | $1.78 | $1.78 | $2.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $691.83
| Facility | | $218.78 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.69 / $3.02
| Professional | | $2.24 | $2.69 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.61 / $10.72
| Facility | | $3.09 | $6.61 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.09 / $4.57
| Professional | | $1.82 | $3.09 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.63 / $3.16
| Professional | | $1.91 | $2.63 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.89
| Facility | | $3.02 | $3.02 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $4.79 / $10.00
| Facility | | $2.69 | $4.79 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $3.63
| Professional | | $2.69 | $2.69 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $338.84 / $691.83
| Facility | | $28.18 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.69 / $3.02
| Professional | | $2.24 | $2.69 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $446.68 / $758.58
| Facility | | $3.02 | $446.68 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.74 / $4.57
| Professional | | $1.26 | $1.74 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.55 / $5.37
| Professional | | $1.35 | $1.55 | $5.37 |