- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $4.90 / $812.83
| Facility | | $1.91 | $4.90 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $91.20
| Professional | | $2.00 | $2.00 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.75 / $50.12
| Facility | | $2.00 | $2.75 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.45 / $2.75
| Professional | | $2.24 | $2.45 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.39 / $10.23
| Facility | | $2.69 | $3.39 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.75
| Professional | | $2.24 | $2.24 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.69 / $69.18
| Facility | | $2.24 | $2.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.69 / $72.44
| Professional | | $2.24 | $2.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.09 / $75.86
| Professional | | $2.82 | $3.09 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.82 / $8.32
| Facility | | $2.57 | $2.82 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.00 / $6.61
| Facility | | $1.86 | $2.00 | $6.61 |
- 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
- $2.00 / $3.02 / $50.12
| Facility | | $2.00 | $3.02 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.45 / $2.75
| Professional | | $2.24 | $2.45 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.51 / $5.89
| Facility | | $1.62 | $2.51 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.69 / $2.95
| Professional | | $2.14 | $2.69 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.95
| Professional | | $2.24 | $2.24 | $2.95 |