- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $29.51 / $95.50
| Facility | | $2.19 | $29.51 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.24 / $21.88
| Professional | | $2.00 | $2.24 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.04
| Facility | | $1.91 | $1.91 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $1.91
| Professional | | $1.91 | $1.91 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.16 / $3.63
| Facility | | $2.04 | $3.16 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $9.55
| Professional | | $2.40 | $2.40 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.95 / $8.13
| Facility | | $2.24 | $2.95 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $3.72
| Professional | | $2.57 | $2.57 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.63 / $2.63
| Facility | | $2.09 | $2.63 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.09 / $2.63
| Professional | | $2.04 | $2.09 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.45 / $4.90
| Facility | | $2.29 | $2.45 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $8.91 / $53,703.18
| Facility | | $2.40 | $8.91 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.09 / $4.17
| Facility | | $2.09 | $2.09 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.34 / $6.17
| Professional | | $2.00 | $2.34 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.63 / $3.16
| Facility | | $2.04 | $2.63 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.09 / $4.07
| Professional | | $2.04 | $2.09 | $4.07 |