- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $19.50 / $91.20
| Facility | | $4.90 | $19.50 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.37 / $15.85
| Professional | | $2.00 | $4.37 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $4.07 / $5.37
| Professional | | $1.38 | $4.07 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $275.42 / $478.63
| Facility | | $3.02 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.34
| Professional | | $2.14 | $2.14 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.60 / $5,011.87
| Facility | | $12.30 | $16.60 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $7.76
| Professional | | $2.57 | $2.57 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $4.79 / $11.22
| Facility | | $2.19 | $4.79 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $3.09 / $4.79
| Professional | | $1.51 | $3.09 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.95 / $4.79
| Professional | | $1.55 | $1.95 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $3.31
| Facility | | $3.31 | $3.31 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.09 / $5.75
| Professional | | $2.45 | $3.09 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $13.18 / $23.44
| Facility | | $4.79 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.51 / $4.79
| Professional | | $2.00 | $2.51 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $363.08 / $1,905.46
| Facility | | $4.07 | $363.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.24
| Professional | | $2.14 | $2.14 | $2.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $5.89 / $26.92
| Facility | | $2.29 | $5.89 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.82 / $5.50
| Professional | | $2.00 | $2.82 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $4.68 / $11.75
| Facility | | $1.15 | $4.68 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $3.47 / $5.37
| Professional | | $1.15 | $3.47 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $3.31 / $3.98
| Facility | | $1.58 | $3.31 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $2.95 / $4.90
| Professional | | $1.48 | $2.95 | $4.90 |