- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $64.57 / $251.19
| Facility | | $7.94 | $64.57 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.63 / $9.55
| Professional | | $2.00 | $2.63 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $2.09
| Professional | | $1.78 | $1.78 | $2.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $138.04 / $138.04
| Facility | | $2.63 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.02 / $4.37
| Professional | | $2.45 | $3.02 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.63 / $7.59
| Facility | | $2.09 | $3.63 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $3.02 / $5.89
| Professional | | $1.55 | $3.02 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $12.88 / $28.18
| Facility | | $2.95 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $4.17
| Professional | | $1.78 | $1.78 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.78
| Professional | | $1.45 | $1.45 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $2.45 / $109.65
| Facility | | $1.26 | $2.45 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.78 / $4.17
| Professional | | $1.26 | $1.78 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $3.02
| Professional | | $1.78 | $1.78 | $3.02 |