- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $10.00 / $72.44
| Facility | | $2.63 | $10.00 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.95 / $5.50
| Professional | | $1.00 | $1.95 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.63
| Facility | | $1.91 | $1.91 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.91 / $5,011.87
| Facility | | $1.62 | $1.91 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $1.82
| Professional | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $6.61 / $7.08
| Facility | | $1.86 | $6.61 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Facility | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.24 / $3.24
| Professional | | $2.82 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $21.38 / $67.61
| Facility | | $6.17 | $21.38 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.63
| Facility | | $1.91 | $1.91 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.82 / $26.30
| Facility | | $1.86 | $2.82 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.45
| Professional | | $1.00 | $1.00 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $10,232.93 / $20,892.96
| Facility | | $676.08 | $10,232.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.86 / $2.09
| Facility | | $1.41 | $1.86 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.86 / $2.14
| Professional | | $1.29 | $1.86 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $3.24
| Professional | | $1.74 | $1.74 | $3.24 |