- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $8.13 / $31.62
| Facility | | $3.80 | $8.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.95 / $8.91
| Professional | | $2.00 | $2.95 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $1,174.90
| Facility | | $3.16 | $3.16 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.16 / $5,011.87
| Facility | | $2.69 | $3.16 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $10.72 / $11.48
| Facility | | $3.09 | $10.72 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $3.09
| Professional | | $3.09 | $3.09 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $3.09
| Facility | | $3.09 | $3.09 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.37 / $5.37
| Professional | | $4.57 | $5.37 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $43.65 / $85.11
| Facility | | $6.17 | $43.65 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.72
| Facility | | $3.16 | $3.16 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $5.62 / $8.71
| Facility | | $3.09 | $5.62 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.02
| Professional | | $2.00 | $2.00 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $870.96 / $1,071.52
| Facility | | $676.08 | $870.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.63 / $4.07
| Facility | | $3.47 | $3.63 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.63 / $7.94
| Professional | | $3.47 | $3.63 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $4.90
| Professional | | $2.95 | $2.95 | $4.90 |