- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $104.71 / $251.19
| Facility | | $1.95 | $104.71 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $5.50
| Professional | | $1.00 | $1.00 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.62 / $1.62
| Facility | | $1.62 | $1.62 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $1.62
| Professional | | $1.29 | $1.29 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.82 / $4.07
| Facility | | $1.51 | $2.82 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.70 / $2.45
| Professional | | $1.29 | $1.70 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.41 / $2.88
| Facility | | $1.00 | $1.41 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $2.82 / $2.82
| Professional | | $0.26 | $2.82 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $15.14 / $63.10
| Facility | | $1.35 | $15.14 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.35 / $2.82
| Professional | | $1.35 | $1.35 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $85.11
| Professional | | $64.57 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.70
| Facility | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.78 / $3.98
| Professional | | $1.29 | $1.78 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.32 / $100.00
| Facility | | $1.32 | $1.32 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.32 / $1.32
| Professional | | $1.32 | $1.32 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.74 / $2.14
| Professional | | $1.26 | $1.74 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.26 / $2.95
| Facility | | $1.26 | $1.26 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.32 / $1.82
| Professional | | $1.32 | $1.32 | $1.82 |