- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $186.21 / $933.25
| Facility | | $1.00 | $186.21 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.51
| Professional | | $1.00 | $1.00 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $3.39 / $5.75
| Facility | | $1.70 | $3.39 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $2.82
| Professional | | $1.70 | $1.70 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.75 / $4.17
| Professional | | $2.40 | $2.75 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.31 / $4.27
| Facility | | $2.34 | $3.31 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.70
| Professional | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.70 / $4.27
| Professional | | $1.45 | $1.70 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $3.89
| Facility | | $1.70 | $1.70 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.04 / $4.07
| Facility | | $1.62 | $2.04 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.04 / $4.07
| Professional | | $1.62 | $2.04 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.09 / $3.72
| Facility | | $1.70 | $2.09 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.70 / $2.14
| Professional | | $1.66 | $1.70 | $2.14 |