- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.82 / $112.20
| Facility | | $1.00 | $2.82 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.04
| Professional | | $1.00 | $1.00 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $6.31
| Facility | | $5.25 | $5.25 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.17 / $1.55
| Professional | | $1.17 | $1.17 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.57 / $4.07
| Facility | | $1.95 | $2.57 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $2.04
| Professional | | $1.74 | $1.74 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $2.69
| Professional | | $2.69 | $2.69 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.14 / $4.07
| Facility | | $1.78 | $2.14 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.98 / $30.20
| Professional | | $2.75 | $3.98 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.02 / $3.39
| Facility | | $2.14 | $3.02 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $2.40
| Professional | | $1.78 | $1.78 | $2.40 |
- 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
- $8.91 / $8.91 / $8.91
| Professional | | $8.91 | $8.91 | $8.91 |