- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $58.88 / $269.15
| Facility | | $4.37 | $58.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.66 / $5.50
| Professional | | $1.00 | $1.66 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Facility | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.15 / $1.48
| Professional | | $1.15 | $1.15 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $2.24 / $3.55
| Facility | | $1.23 | $2.24 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.51 / $2.19
| Professional | | $1.15 | $1.51 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $1.10 / $2.14
| Facility | | $0.66 | $1.10 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $2.19 / $2.19
| Professional | | $0.26 | $2.19 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $22.39 / $58.88
| Facility | | $2.82 | $22.39 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $0.95 / $2.19
| Professional | | $0.95 | $0.95 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $64.57 / $85.11
| Professional | | $1.20 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.02 / $1.02
| Facility | | $1.02 | $1.02 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.17 / $3.02
| Professional | | $1.12 | $1.17 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $100.00
| Facility | | $1.20 | $1.20 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $1.20
| Professional | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.95
| Professional | | $1.58 | $1.58 | $1.95 |
- 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
- $1.20 / $1.20 / $1.78
| Professional | | $1.20 | $1.20 | $1.78 |