- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $25.70 / $245.47
| Facility | | $4.27 | $25.70 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.47 / $5.25
| Professional | | $2.00 | $3.47 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $15.49 / $28.18
| Facility | | $5.25 | $15.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $4.17 / $5.50
| Professional | | $2.57 | $4.17 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $7.08 / $33.88
| Facility | | $4.27 | $7.08 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $5.50
| Facility | | $4.68 | $4.68 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.47 / $25.12
| Facility | | $5.50 | $10.47 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $8.13
| Professional | | $2.75 | $3.47 | $8.13 |
- 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
- $9.33 / $9.33 / $9.33
| Professional | | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.68 / $83.18
| Facility | | $3.55 | $4.68 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.27 / $8.51
| Professional | | $2.51 | $4.27 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.98 / $3.98
| Professional | | $3.55 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.68 / $14.79
| Facility | | $3.80 | $4.68 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $7.94
| Professional | | $2.75 | $3.47 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.68 / $5.62
| Facility | | $2.00 | $4.68 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.75 / $4.68
| Professional | | $2.00 | $2.75 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.45 / $4.68
| Professional | | $1.82 | $2.45 | $4.68 |