- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $5.13 / $234.42
| Facility | | $1.70 | $5.13 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.70 / $5.50
| Professional | | $1.00 | $1.70 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.74 / $2.19
| Professional | | $1.32 | $1.74 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $17.38 / $35.48
| Professional | | $1.86 | $17.38 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.04 / $7.94
| Facility | | $1.32 | $2.04 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $1.48 / $177.83
| Professional | | $1.32 | $1.48 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.04 / $2.51
| Professional | | $1.62 | $2.04 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $4.47 / $5.75
| Professional | | $2.29 | $4.47 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.82 / $3.63
| Professional | | $1.45 | $2.82 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $7.94
| Facility | | $2.24 | $2.24 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.70 / $2.04
| Professional | | $1.51 | $1.70 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $2.04
| Facility | | $1.86 | $1.86 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.86 / $2.04
| Professional | | $1.48 | $1.86 | $2.04 |