- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $5.62 / $630.96
| Facility | | $2.00 | $5.62 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $5.13
| Professional | | $2.00 | $2.00 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.24 / $3.31
| Facility | | $3.16 | $3.24 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $3.55
| Professional | | $2.82 | $2.82 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $4.57 / $7.41
| Facility | | $2.69 | $4.57 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $5.37 / $169.82
| Professional | | $2.69 | $5.37 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $4.07 / $4.37
| Professional | | $3.80 | $4.07 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $3.55
| Professional | | $3.55 | $3.55 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $9.55
| Professional | | $3.02 | $3.02 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.39 / $5.37
| Professional | | $2.75 | $3.39 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.31
| Facility | | $3.02 | $3.02 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.31
| Professional | | $3.02 | $3.02 | $3.31 |