- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $91.20 / $407.38
| Facility | | $3.72 | $91.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $218.78
| Professional | | $2.00 | $3.02 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $3.31
| Professional | | $2.75 | $2.75 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $9.12 / $17.78
| Facility | | $3.72 | $9.12 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.55 / $1.55
| Professional | | $1.55 | $1.55 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $11.48 / $151.36
| Facility | | $2.00 | $11.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.80 / $10.96
| Professional | | $2.24 | $3.80 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $6.61 / $18.62
| Facility | | $3.09 | $6.61 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $177.83
| Professional | | $102.33 | $102.33 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.80 / $10.47
| Facility | | $2.75 | $3.80 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.82 / $60.26
| Professional | | $2.00 | $2.82 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.72 / $4.27
| Professional | | $3.31 | $3.72 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.08 / $30.20
| Professional | | $3.02 | $7.08 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.63 / $8.51
| Facility | | $2.75 | $3.63 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.75 / $3.89
| Professional | | $2.75 | $2.75 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.25 / $5.25
| Facility | | $3.80 | $5.25 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $2.95 / $5.37
| Professional | | $2.75 | $2.95 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.75 / $3.47
| Professional | | $2.51 | $2.75 | $3.47 |