- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $6.76 / $467.74
| Facility | | $2.95 | $6.76 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $16.98 / $83.18
| Professional | | $2.00 | $16.98 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $6.03
| Professional | | $2.95 | $2.95 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $8.32
| Facility | | $6.17 | $8.32 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $16.22 / $16.60
| Professional | | $15.85 | $16.22 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.16 / $5.25
| Professional | | $2.95 | $3.16 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.72 / $26.30
| Facility | | $2.09 | $3.72 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.47 / $537.03
| Professional | | $2.09 | $3.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.55 / $5.62
| Professional | | $3.16 | $3.55 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $4.68 / $5.62
| Professional | | $3.24 | $4.68 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $724.44
| Facility | | $616.60 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.55 / $7.76
| Facility | | $2.95 | $3.55 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.09 / $37.15
| Professional | | $2.95 | $3.09 | $37.15 |