- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $446.68 / $1,174.90
| Facility | | $1.32 | $446.68 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $446.68 / $5,370.32
| Professional | | $56.23 | $446.68 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $77.62
| Professional | | $56.23 | $63.10 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $6.17 / $11.75
| Facility | | $2.40 | $6.17 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Professional | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $1.55 / $512.86
| Facility | | $0.33 | $1.55 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.91 / $1.70
| Professional | | $0.33 | $0.91 | $1.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.32 / $3.55
| Facility | | $0.65 | $1.32 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.52
| Professional | | $0.52 | $0.52 | $0.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.78 / $16.22
| Facility | | $0.65 | $0.78 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $245.47 / $5,128.61
| Professional | | $0.72 | $245.47 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.66 / $1.00
| Professional | | $0.63 | $0.66 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $11.22 / $30.20
| Professional | | $0.71 | $11.22 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.76 / $5.50
| Facility | | $0.65 | $0.76 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.79
| Professional | | $0.52 | $0.52 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $1.00 / $1.00
| Facility | | $0.74 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.69 / $5.62
| Professional | | $0.62 | $0.69 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.65 / $0.81
| Professional | | $0.50 | $0.65 | $0.81 |