- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $9.55 / $245.47
| Facility | | $2.14 | $9.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $3.24 / $72.44
| Professional | | $1.00 | $3.24 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.29
| Facility | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.29 / $2.29
| Professional | | $2.04 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $9.33
| Facility | | $3.09 | $3.09 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.51
| Professional | | $2.04 | $2.04 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.04 / $5.62
| Facility | | $1.95 | $2.04 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.04 / $5.62
| Professional | | $1.95 | $2.04 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.19 / $75.86
| Professional | | $2.00 | $2.19 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $4.17
| Facility | | $2.00 | $2.00 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $5.13 / $5.13
| Facility | | $2.57 | $5.13 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.57 / $2.57
| Professional | | $2.29 | $2.57 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.29 / $2.29
| Facility | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.29 / $2.29
| Professional | | $2.04 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.19 / $5.25
| Facility | | $1.45 | $2.19 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.19 / $2.88
| Professional | | $1.95 | $2.19 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $2.95
| Professional | | $1.95 | $1.95 | $2.95 |