- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.09 / $6,760.83
| Facility | | $2.14 | $3.09 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2,344.23
| Professional | | $2.00 | $2.00 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $4.79
| Facility | | $2.63 | $2.63 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.69
| Professional | | $2.14 | $2.14 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.79 / $7.08
| Facility | | $2.63 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.63 / $3.80
| Professional | | $2.09 | $2.63 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.04 / $4.27
| Facility | | $1.32 | $2.04 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.17 / $4.17
| Professional | | $3.09 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.00 / $4.27
| Facility | | $1.32 | $2.00 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.31
| Professional | | $2.00 | $2.00 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $85.11
| Professional | | $54.95 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.95 / $1.95
| Facility | | $1.91 | $1.95 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.29 / $6.46
| Professional | | $2.14 | $2.29 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $85.11
| Facility | | $2.04 | $2.04 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.88 / $3.55
| Professional | | $1.70 | $2.88 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $4.68
| Facility | | $2.04 | $2.04 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.88
| Professional | | $2.04 | $2.04 | $2.88 |