- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $63.10 / $107.15
| Facility | | $19.95 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $19.95
| Professional | | $2.00 | $2.69 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.94 / $8.13
| Facility | | $6.46 | $7.94 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $12.02
| Professional | | $1.48 | $1.48 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $3.16
| Facility | | $2.04 | $2.04 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $9.55 / $15.14
| Facility | | $8.13 | $9.55 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.17 / $9.33
| Professional | | $3.31 | $4.17 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $6.46 / $21.88
| Facility | | $2.63 | $6.46 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $54.95 / $100.00
| Facility | | $3.63 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.29 / $6.76
| Professional | | $1.74 | $2.29 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $9.55 / $64.57
| Professional | | $1.48 | $9.55 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $7.76
| Facility | | $3.63 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $4.90 / $8.51
| Professional | | $2.24 | $4.90 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $7.59 / $50.12
| Professional | | $3.98 | $7.59 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $60.26
| Facility | | $6.03 | $6.03 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.95 / $2.88
| Professional | | $1.58 | $1.95 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $6.76
| Professional | | $6.31 | $6.31 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $13.80 / $20.42
| Professional | | $6.76 | $13.80 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.63 / $354.81
| Facility | | $1.51 | $2.63 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.40 / $10.72
| Professional | | $1.51 | $2.40 | $10.72 |