- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.58 / $2.51
| Professional | | $1.51 | $1.58 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $4.47 / $7.76
| Facility | | $1.82 | $4.47 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $0.37
| Professional | | $0.37 | $0.37 | $0.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.58 / $1.55
| Facility | | $0.26 | $0.58 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $0.23
| Professional | | $0.23 | $0.23 | $0.23 |
- 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
- $4,073.80 / $4,073.80 / $4,073.80
| Professional | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.40 / $1.51
| Facility | | $0.36 | $0.40 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.38 / $1.62
| Professional | | $0.23 | $0.38 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.25 / $0.56
| Professional | | $0.23 | $0.25 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.47 / $1.20 / $30.20
| Professional | | $0.47 | $1.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.40 / $1.51
| Facility | | $0.36 | $0.40 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $0.32
| Professional | | $0.23 | $0.23 | $0.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.35 / $0.54
| Facility | | $0.23 | $0.35 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.36 / $0.36
| Professional | | $0.33 | $0.36 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.36 / $0.45
| Professional | | $0.21 | $0.36 | $0.45 |