- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $8.71 / $229.09
| Facility | | $2.40 | $8.71 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $4.47
| Professional | | $2.00 | $2.00 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $4.37 / $13.18
| Facility | | $2.19 | $4.37 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.40 / $3.80
| Professional | | $2.04 | $2.40 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $2.69
| Facility | | $2.69 | $2.69 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $2.34
| Facility | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.27 / $6.61
| Facility | | $3.80 | $4.27 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.40
| Professional | | $2.04 | $2.04 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $6.92 / $30.90
| Facility | | $1.95 | $6.92 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $3.55
| Professional | | $2.04 | $2.04 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.57 / $3.31
| Professional | | $2.04 | $2.57 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $3.39 / $4.68
| Professional | | $1.91 | $3.39 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.47 / $3.47
| Facility | | $1.95 | $3.47 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.04 / $2.69
| Professional | | $1.58 | $2.04 | $2.69 |