- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.82 / $3.98
| Facility | | $1.95 | $2.82 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $3.98
| Professional | | $1.00 | $1.00 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $3.24
| Professional | | $1.29 | $1.29 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.04 / $2.04
| Facility | | $1.91 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $53,703.18
| Facility | | $7.76 | $7.76 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.12 / $1.62
| Professional | | $1.02 | $1.12 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.17 / $9.55
| Facility | | $2.51 | $4.17 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.55 / $5.01
| Professional | | $2.24 | $3.55 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Facility | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Professional | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $50,118.72 / $75,857.76
| Facility | | $0.39 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.40 / $2.40
| Professional | | $1.62 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $9.33
| Facility | | $6.92 | $6.92 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $2.19 / $4.79
| Professional | | $1.05 | $2.19 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.20
| Facility | | $0.17 | $0.17 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Professional | | $0.17 | $0.17 | $0.17 |