- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $45.71 / $426.58
| Facility | | $2.45 | $45.71 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $4.07 / $89.13
| Professional | | $1.00 | $4.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.00 / $2.04
| Professional | | $1.95 | $2.00 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $9.77 / $31.62
| Facility | | $4.07 | $9.77 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.89 / $3.89
| Professional | | $3.47 | $3.89 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.07 / $5.25
| Facility | | $2.88 | $4.07 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.88
| Professional | | $2.04 | $2.04 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $5.62 / $14.79
| Professional | | $2.00 | $5.62 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $2.57
| Professional | | $2.57 | $2.57 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.57 / $3.02
| Professional | | $2.04 | $2.57 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.63 / $3.63
| Facility | | $2.19 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.40 / $3.47
| Professional | | $1.95 | $2.40 | $3.47 |