- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Facility | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $7.76
| Professional | | $1.00 | $1.00 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.85 / $2.14
| Facility | | $0.68 | $0.85 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $0.95 / $2.63
| Professional | | $0.91 | $0.95 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.51 / $3.89
| Facility | | $1.91 | $2.51 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $3.31 / $6.76
| Professional | | $1.74 | $3.31 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.29
| Facility | | $1.10 | $1.10 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $0.93 / $1.12
| Professional | | $0.93 | $0.93 | $1.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.82 / $2.45
| Professional | | $1.48 | $1.82 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.66 / $3.02
| Professional | | $1.00 | $1.66 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.49 / $13.49
| Professional | | $9.12 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $32.36 / $33.11
| Professional | | $1.82 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $1.74 / $2.45
| Facility | | $0.52 | $1.74 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $0.93 / $1.78
| Professional | | $0.93 | $0.93 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $3.39
| Professional | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $1.66
| Professional | | $1.48 | $1.48 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.71 / $0.83
| Facility | | $0.49 | $0.71 | $0.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $0.81 / $1.95
| Professional | | $0.69 | $0.81 | $1.95 |