- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $63.10 / $501.19
| Facility | | $6.17 | $63.10 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.62 / $1.62
| Professional | | $1.12 | $1.62 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.49 / $0.93
| Facility | | $0.20 | $0.49 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.33 / $0.33
| Professional | | $0.33 | $0.33 | $0.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $1.12
| Facility | | $0.68 | $0.68 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.93 / $2.63
| Facility | | $0.39 | $0.93 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.39 / $0.39
| Professional | | $0.39 | $0.39 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $204.17
| Facility | | $190.55 | $190.55 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $44.67 / $549.54
| Facility | | $0.59 | $44.67 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $1.12 / $1.62
| Professional | | $0.32 | $1.12 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.41 / $0.43
| Professional | | $0.41 | $0.41 | $0.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.38 / $0.52 / $1.23
| Facility | | $0.38 | $0.52 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.39 / $0.39
| Professional | | $0.39 | $0.39 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.54 / $0.54
| Facility | | $0.40 | $0.54 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.41 / $0.41
| Professional | | $0.33 | $0.41 | $0.41 |