- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $81.28 / $371.54
| Facility | | $1.91 | $81.28 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $34.67
| Professional | | $1.00 | $1.00 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $2.40
| Professional | | $1.45 | $1.45 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $3.39
| Professional | | $1.45 | $1.45 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.75 / $3.63
| Facility | | $2.04 | $2.75 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.45 / $1.86
| Professional | | $1.23 | $1.45 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.51 / $3.55
| Professional | | $2.51 | $2.51 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.29 / $3.47
| Facility | | $1.45 | $2.29 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.74 / $3.31
| Facility | | $1.38 | $1.74 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.74 / $3.31
| Professional | | $1.38 | $1.74 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.45 / $6.31
| Facility | | $2.45 | $2.45 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.82
| Professional | | $1.45 | $1.45 | $1.82 |