- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.89 / $549.54
| Facility | | $1.95 | $3.89 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $5.75 / $58.88
| Professional | | $1.00 | $5.75 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $3.98
| Professional | | $1.95 | $1.95 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.50 / $5.75
| Facility | | $4.37 | $5.50 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.72 / $10.96
| Professional | | $10.47 | $10.72 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.45 / $3.47
| Professional | | $2.04 | $2.45 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.75 / $6.46
| Facility | | $1.74 | $2.75 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.34 / $60.26
| Professional | | $1.74 | $2.34 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.63 / $3.47
| Professional | | $2.57 | $2.63 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.31 / $4.27
| Professional | | $2.63 | $3.31 | $4.27 |
- 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
- $2.04 / $2.69 / $5.89
| Facility | | $2.04 | $2.69 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.24 / $3.31
| Professional | | $1.95 | $2.24 | $3.31 |