- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $13.80 / $331.13
| Facility | | $1.82 | $13.80 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $2.75 / $21.38
| Professional | | $1.15 | $2.75 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $83.18
| Professional | | $2.57 | $2.57 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $0.98 / $1.26
| Facility | | $0.87 | $0.98 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.85 / $2.95
| Professional | | $0.83 | $0.85 | $2.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $2.29
| Facility | | $1.82 | $1.82 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.17 / $2.51
| Professional | | $0.89 | $1.17 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $1.45 / $1.95
| Facility | | $0.87 | $1.45 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $0.85
| Professional | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.91 / $2.04
| Professional | | $0.74 | $0.91 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.45 / $2.63
| Professional | | $1.32 | $1.45 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $0.81
| Professional | | $0.81 | $0.81 | $0.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.32 / $2.14
| Facility | | $0.85 | $1.32 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $1.78
| Professional | | $0.85 | $0.85 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.93 / $1.45
| Professional | | $0.68 | $0.93 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $2.75
| Facility | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.83 / $2.24
| Professional | | $0.83 | $0.83 | $2.24 |