- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $89.13 / $575.44
| Facility | | $5.13 | $89.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $8.91
| Professional | | $2.00 | $2.00 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $4.17
| Facility | | $3.02 | $3.02 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.02 / $5,011.87
| Facility | | $2.57 | $3.02 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $8.32 / $8.91
| Facility | | $2.40 | $8.32 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.45
| Professional | | $2.40 | $2.40 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.57 / $3.24
| Professional | | $2.45 | $2.57 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.40
| Facility | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.39 / $7.08
| Professional | | $2.40 | $3.39 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $43.65
| Facility | | $18.62 | $25.70 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $4.17
| Facility | | $3.02 | $3.02 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $4.37 / $11.75
| Facility | | $2.40 | $4.37 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.02
| Professional | | $2.00 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $11.48 / $13.18
| Professional | | $0.60 | $11.48 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.24 / $4.17
| Facility | | $2.57 | $3.24 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $3.24 / $4.68
| Professional | | $0.81 | $3.24 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.09 / $4.57
| Professional | | $2.75 | $3.09 | $4.57 |