- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.63 / $54.95
| Facility | | $1.86 | $3.63 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.14
| Professional | | $1.00 | $1.00 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $2.82 / $5.62
| Facility | | $1.29 | $2.82 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $1.78
| Professional | | $1.78 | $1.78 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $79.43
| Facility | | $1.86 | $1.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $4.47 / $12.59
| Facility | | $1.86 | $4.47 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $100.00
| Facility | | $95.50 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.91 / $3.16
| Facility | | $1.82 | $1.91 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.86 / $2.24
| Professional | | $1.00 | $1.86 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.32 / $2.88
| Professional | | $1.29 | $1.32 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $3.39 / $3.39
| Professional | | $0.60 | $3.39 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.91 / $3.09
| Facility | | $1.82 | $1.91 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $2.14
| Professional | | $1.86 | $1.86 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $3.02 / $3.02
| Facility | | $1.91 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.86 / $1.91
| Professional | | $1.82 | $1.86 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.86 / $2.34
| Professional | | $1.66 | $1.86 | $2.34 |