- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $4.07 / $60.26
| Facility | | $1.00 | $4.07 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.38
| Professional | | $1.00 | $1.00 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $2.45
| Professional | | $1.66 | $1.66 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $6.92 / $10.96
| Facility | | $2.19 | $6.92 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.74 / $2.51
| Professional | | $1.38 | $1.74 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.35 / $1.95
| Facility | | $1.35 | $1.35 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.04 / $7.76
| Professional | | $1.86 | $2.04 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $3.02
| Facility | | $1.70 | $1.70 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $616.60
| Professional | | $1.70 | $1.70 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $32.36 / $70.79
| Professional | | $1.35 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $1.95
| Facility | | $0.85 | $0.85 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.95 / $2.51
| Professional | | $1.48 | $1.95 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.40 / $4.27
| Professional | | $1.62 | $2.40 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $85.11 / $100.00
| Facility | | $1.35 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $2.82 / $616.60
| Professional | | $1.35 | $2.82 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.24 / $2.75
| Professional | | $2.04 | $2.24 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $3.47
| Facility | | $1.48 | $1.48 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.35 / $2.00
| Professional | | $1.35 | $1.35 | $2.00 |