- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $1,548.82
| Facility | | $123.03 | $123.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $3.72
| Professional | | $2.34 | $2.34 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.35
| Professional | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.54 / $0.54 / $0.54
| Professional | | $0.54 | $0.54 | $0.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.33 / $0.33
| Facility | | $0.33 | $0.33 | $0.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.79 / $1.20
| Professional | | $0.49 | $0.79 | $1.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.55 / $0.55 / $0.55
| Facility | | $0.55 | $0.55 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.39 / $0.55
| Professional | | $0.33 | $0.39 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.41 / $0.41
| Professional | | $0.41 | $0.41 | $0.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $1,548.82
| Facility | | $851.14 | $851.14 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.23 / $1.23
| Professional | | $1.23 | $1.23 | $1.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.79 / $1.10
| Professional | | $0.60 | $0.79 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.38 / $0.52 / $0.68
| Facility | | $0.38 | $0.52 | $0.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.52 / $0.68
| Professional | | $0.41 | $0.52 | $0.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.28 / $0.47
| Professional | | $0.21 | $0.28 | $0.47 |