- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $10.23 / $69.18
| Facility | | $1.95 | $10.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.78 / $4.47
| Professional | | $0.95 | $1.78 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $57.54 / $64.57
| Professional | | $1.00 | $57.54 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.41 / $1.70
| Facility | | $1.41 | $1.41 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.95 / $1.95
| Professional | | $0.65 | $1.95 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $1.00 / $1.58
| Facility | | $0.76 | $1.00 | $1.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.76
| Professional | | $0.68 | $0.68 | $0.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.79 / $1.95
| Facility | | $0.65 | $0.79 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $1,698.24
| Facility | | $208.93 | $208.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $1.12 / $1.23
| Facility | | $0.78 | $1.12 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $1.00
| Professional | | $0.65 | $0.65 | $1.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |