- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $47.86 / $380.19
| Facility | | $2.19 | $47.86 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.09 / $56.23
| Professional | | $2.00 | $2.09 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $2.69
| Facility | | $2.69 | $2.69 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.75
| Professional | | $2.19 | $2.19 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $3.47
| Facility | | $2.29 | $2.29 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $5.37
| Professional | | $2.29 | $2.29 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.55 / $6.61
| Facility | | $2.82 | $3.55 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.69 / $4.27
| Professional | | $2.14 | $2.69 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.29 / $5.01
| Facility | | $2.00 | $2.29 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $4.57 / $4.79
| Professional | | $1.86 | $4.57 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $11.48
| Facility | | $1.95 | $1.95 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.88 / $147.91
| Professional | | $1.95 | $2.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $64.57 / $70.79
| Professional | | $2.09 | $64.57 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.27 / $4.37
| Facility | | $2.82 | $4.27 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.82 / $4.68
| Professional | | $2.14 | $2.82 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.89 / $7.08
| Professional | | $2.14 | $3.89 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $85.11 / $489.78
| Facility | | $2.09 | $85.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.90 / $151.36
| Professional | | $2.09 | $4.90 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.82 / $3.63
| Professional | | $2.09 | $2.82 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $6.76
| Facility | | $2.88 | $2.88 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $4.07 / $32.36
| Professional | | $2.09 | $4.07 | $32.36 |