- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $11.75 / $58.88
| Facility | | $1.95 | $11.75 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.19 / $3.02
| Professional | | $1.00 | $2.19 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.55 / $1.78
| Professional | | $1.23 | $1.55 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $8.51 / $15.14
| Facility | | $3.55 | $8.51 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $2.04 / $5.50
| Professional | | $1.41 | $2.04 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.72 / $28.84
| Facility | | $2.34 | $3.72 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.45 / $4.07
| Professional | | $1.78 | $2.45 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.51
| Facility | | $2.29 | $2.29 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $5.62 / $13.18
| Facility | | $2.95 | $5.62 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.95 / $4.47
| Professional | | $1.48 | $1.95 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $5.25
| Professional | | $5.25 | $5.25 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.51 / $30.20
| Facility | | $1.95 | $2.51 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.29 / $4.57
| Professional | | $1.00 | $2.29 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.14 / $2.14
| Professional | | $1.91 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.61 / $7.41
| Facility | | $4.17 | $6.61 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.51 / $9.33
| Facility | | $2.04 | $2.51 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.91 / $4.37
| Professional | | $1.48 | $1.91 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $2.51 / $3.02
| Facility | | $1.12 | $2.51 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.48 / $2.51
| Professional | | $1.07 | $1.48 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.32 / $2.51
| Professional | | $1.00 | $1.32 | $2.51 |