- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $23.99 / $331.13
| Facility | | $3.80 | $23.99 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.72
| Professional | | $2.00 | $2.00 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $3.39 / $6.92
| Facility | | $1.45 | $3.39 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $7.94 / $33.88
| Facility | | $1.00 | $7.94 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $5.25 / $14.45
| Facility | | $2.14 | $5.25 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $21.88 / $269.15
| Facility | | $2.69 | $21.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.14 / $4.79
| Professional | | $2.00 | $2.14 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.51
| Professional | | $2.19 | $2.19 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $3.09 / $9.77
| Facility | | $2.14 | $3.09 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.70 / $1.70
| Facility | | $1.26 | $1.70 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $2.14 / $2.14
| Professional | | $1.02 | $2.14 | $2.14 |