- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $123.03 / $630.96
| Facility | | $2.57 | $123.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $72.44 / $186.21
| Professional | | $1.41 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $16.98 / $91.20
| Professional | | $8.91 | $16.98 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.56 / $1.35
| Facility | | $0.22 | $0.56 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.06 / $0.06
| Professional | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $1.17 / $398.11
| Facility | | $0.49 | $1.17 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.49 / $0.49
| Professional | | $0.49 | $0.49 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Facility | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $1.35 / $3.89
| Facility | | $0.58 | $1.35 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $0.56
| Professional | | $0.56 | $0.56 | $0.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $95.50 / $676.08
| Facility | | $0.74 | $95.50 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $70.79 / $186.21
| Professional | | $1.07 | $70.79 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.68 / $1.82
| Facility | | $0.56 | $0.68 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $0.56
| Professional | | $0.56 | $0.56 | $0.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $0.89 / $0.89
| Facility | | $0.66 | $0.89 | $0.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.48 / $0.48 / $0.54
| Professional | | $0.48 | $0.48 | $0.54 |