- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $17.78 / $85.11
| Facility | | $4.17 | $17.78 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $6.17 / $18.20
| Professional | | $1.70 | $6.17 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $95.50
| Professional | | $63.10 | $74.13 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $3.02 / $6.31
| Facility | | $1.29 | $3.02 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $1.29
| Professional | | $1.29 | $1.29 | $1.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $7.08 / $77.62
| Facility | | $0.83 | $7.08 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Facility | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.14 / $6.03
| Facility | | $1.00 | $2.14 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.89
| Professional | | $0.89 | $0.89 | $0.89 |
- 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
- $2.19 / $2.19 / $2.51
| Professional | | $2.19 | $2.19 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $16.60 / $83.18
| Facility | | $1.95 | $16.60 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $4.90 / $18.20
| Professional | | $1.23 | $4.90 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $0.76 / $0.85
| Professional | | $0.76 | $0.76 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $1.26 / $2.82
| Facility | | $0.76 | $1.26 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.89
| Professional | | $0.89 | $0.89 | $0.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.45 / $1.45
| Facility | | $1.07 | $1.45 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.74 / $0.87
| Professional | | $0.74 | $0.74 | $0.87 |