- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $3.31 / $141.25
| Facility | | $1.00 | $3.31 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $3.98
| Professional | | $1.00 | $1.00 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $3.89
| Professional | | $1.86 | $1.86 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.75
| Professional | | $2.14 | $2.14 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $1.26
| Professional | | $1.26 | $1.26 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.72 / $5.13
| Facility | | $2.51 | $3.72 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $3.72 / $5.13
| Professional | | $2.51 | $3.72 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.48 / $64.57
| Professional | | $1.23 | $1.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.45
| Facility | | $2.40 | $2.40 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.80 / $4.68
| Facility | | $2.04 | $3.80 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.40
| Professional | | $2.04 | $2.04 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.14 / $2.75
| Professional | | $2.04 | $2.14 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.83 / $1.95
| Facility | | $0.83 | $0.83 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.05 / $2.00
| Professional | | $1.00 | $1.05 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $3.72
| Professional | | $2.14 | $2.14 | $3.72 |