- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $89.13 / $363.08
| Facility | | $2.40 | $89.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $56.23
| Professional | | $1.00 | $2.00 | $56.23 |
- 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
- $2.69 / $3.63 / $8.51
| Facility | | $2.69 | $3.63 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.29 / $3.09
| Professional | | $2.04 | $2.29 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $5.25
| Facility | | $2.88 | $2.88 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.09
| Professional | | $2.04 | $2.04 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.69 / $2.88
| Professional | | $1.82 | $2.69 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.34 / $5.37
| Facility | | $1.95 | $2.34 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.13 / $30.20
| Professional | | $5.01 | $5.13 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $3.63
| Facility | | $3.63 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $2.04 / $2.51
| Professional | | $1.74 | $2.04 | $2.51 |