- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $1.26
| Facility | | $1.26 | $1.26 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.26
| Professional | | $1.00 | $1.00 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $23.99 / $23.99
| Professional | | $0.71 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $2.51
| Facility | | $1.26 | $1.26 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.26
| Professional | | $1.00 | $1.00 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $32.36
| Professional | | $23.99 | $23.99 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $2.51
| Facility | | $1.26 | $1.26 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.24 / $4.79
| Professional | | $2.09 | $2.24 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.26
| Professional | | $1.00 | $1.00 | $1.26 |