- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $5.75 / $95.50
| Facility | | $2.19 | $5.75 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.32 / $5.25
| Professional | | $1.00 | $1.32 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.32 / $1.32
| Professional | | $1.32 | $1.32 | $1.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.48 / $2.00
| Facility | | $1.38 | $1.48 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.35 / $4.37
| Professional | | $1.32 | $1.35 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.02 / $3.72
| Facility | | $2.88 | $3.02 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.70 / $3.80
| Professional | | $1.32 | $1.70 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.19 / $2.95
| Facility | | $1.32 | $2.19 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $1.29
| Professional | | $1.29 | $1.29 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.45 / $3.98
| Professional | | $1.15 | $1.45 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.17 / $1.17
| Professional | | $1.17 | $1.17 | $1.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.95 / $3.24
| Facility | | $1.29 | $1.95 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $1.41
| Professional | | $1.29 | $1.29 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $1.91
| Professional | | $1.91 | $1.91 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.41 / $2.19
| Professional | | $1.02 | $1.41 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $3.47
| Facility | | $3.47 | $3.47 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.32 / $3.24
| Professional | | $1.32 | $1.32 | $3.24 |