- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.75 / $3.80
| Facility | | $1.00 | $2.75 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.51
| Professional | | $1.00 | $1.00 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $4.17 / $8.13
| Facility | | $1.66 | $4.17 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.35 / $2.14
| Professional | | $1.35 | $1.35 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $3.80 / $10.72
| Facility | | $1.78 | $3.80 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.24 / $3.24
| Facility | | $1.58 | $2.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.20 / $2.75
| Professional | | $1.00 | $1.20 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.51 / $1.58
| Professional | | $1.51 | $1.51 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.24 / $5.01
| Facility | | $1.58 | $2.24 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.58 / $2.51
| Facility | | $1.51 | $1.58 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.58 / $1.58
| Professional | | $1.51 | $1.58 | $1.58 |