- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $50.12 / $302.00
| Facility | | $1.26 | $50.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.05 / $64.57
| Professional | | $1.00 | $1.05 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.17 / $93.33
| Professional | | $1.05 | $1.17 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $1.38
| Facility | | $0.65 | $0.65 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.65
| Professional | | $0.65 | $0.65 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.05 / $1.35
| Professional | | $0.93 | $1.05 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $2.19 / $6.03
| Facility | | $0.89 | $2.19 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.89
| Professional | | $0.89 | $0.89 | $0.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.05 / $1.86
| Facility | | $0.65 | $1.05 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.05 / $2.09
| Professional | | $1.00 | $1.05 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.05 / $1.62
| Professional | | $0.95 | $1.05 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.58 / $30.20
| Professional | | $1.12 | $1.58 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $1.05 / $1.74
| Facility | | $0.63 | $1.05 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $1.15
| Professional | | $0.89 | $0.89 | $1.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.78 / $1.78
| Facility | | $1.32 | $1.78 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.10 / $3.63
| Professional | | $1.05 | $1.10 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.05 / $1.12
| Professional | | $0.89 | $1.05 | $1.12 |