- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $79.43 / $173.78
| Facility | | $4.90 | $79.43 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.72 / $134.90
| Professional | | $2.00 | $3.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.95 / $3.09
| Professional | | $2.51 | $2.95 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.31 / $19.05
| Facility | | $3.16 | $6.31 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.39 / $5.50
| Professional | | $2.95 | $3.39 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $5.89
| Professional | | $2.95 | $2.95 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.45 / $3.72
| Facility | | $2.45 | $2.45 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.45 / $5.75
| Professional | | $2.45 | $2.45 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $6.17 / $9.77
| Facility | | $5.50 | $6.17 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $5.01
| Professional | | $2.95 | $2.95 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $9.12 / $24.55
| Facility | | $2.95 | $9.12 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $6.61
| Professional | | $2.95 | $2.95 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.09 / $3.80
| Professional | | $2.45 | $3.09 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.63 / $5.89
| Professional | | $2.95 | $3.63 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $6.31 / $6.31
| Facility | | $3.55 | $6.31 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.02 / $37.15
| Professional | | $2.75 | $3.02 | $37.15 |