- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $14.79 / $104.71
| Facility | | $3.72 | $14.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $2.82 / $21.38
| Professional | | $1.15 | $2.82 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.38 / $83.18
| Professional | | $1.38 | $1.38 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $1.20
| Facility | | $0.85 | $0.85 | $1.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.89 / $5,011.87
| Facility | | $0.78 | $0.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $0.85
| Professional | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $2.95 / $3.16
| Facility | | $0.85 | $2.95 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $0.85
| Professional | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $0.85
| Facility | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.48 / $1.48
| Professional | | $1.29 | $1.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $8.51 / $19.95
| Facility | | $2.29 | $8.51 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $467.74
| Facility | | $0.85 | $0.85 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $2.24 / $93.33
| Facility | | $1.10 | $2.24 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.29 / $2.51
| Professional | | $1.10 | $1.29 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.85 / $0.93
| Facility | | $0.59 | $0.85 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.85 / $0.93
| Professional | | $0.59 | $0.85 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.83 / $1.51
| Professional | | $0.83 | $0.83 | $1.51 |