- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $8.91 / $263.03
| Facility | | $1.95 | $8.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $109.65
| Professional | | $1.00 | $1.00 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $0.91 / $1.91
| Professional | | $0.87 | $0.91 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $3.24 / $5.62
| Facility | | $1.23 | $3.24 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $2.51 / $3.55
| Professional | | $0.93 | $2.51 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $1.78 / $2.24
| Facility | | $0.66 | $1.78 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $3.55 / $3.55
| Professional | | $0.26 | $3.55 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $3.98 / $758.58
| Facility | | $1.74 | $3.98 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $1.74 / $2.24
| Professional | | $0.69 | $1.74 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $58.88 / $89.13
| Professional | | $2.57 | $58.88 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $0.91 / $0.91
| Facility | | $0.91 | $0.91 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.70 / $1.95
| Professional | | $1.51 | $1.70 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $3.89 / $5.50
| Professional | | $0.95 | $3.89 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $85.11 / $100.00
| Facility | | $1.91 | $85.11 | $100.00 |
- 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
- $0.83 / $2.57 / $3.16
| Professional | | $0.83 | $2.57 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $1.51 / $3.47
| Facility | | $0.16 | $1.51 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.91 / $2.29
| Professional | | $0.93 | $1.91 | $2.29 |