- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $3.89
| Facility | | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $3.89 / $3.89
| Professional | | $1.00 | $3.89 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.35 / $0.89
| Facility | | $0.28 | $0.35 | $0.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.39 / $1.32
| Professional | | $0.37 | $0.39 | $1.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.23 / $1.86
| Facility | | $0.93 | $1.23 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.66 / $3.39
| Professional | | $0.85 | $1.66 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.54 / $0.54 / $0.55
| Facility | | $0.54 | $0.54 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.55
| Professional | | $0.46 | $0.46 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $1.00 / $1.23
| Professional | | $0.74 | $1.00 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $0.87 / $1.62
| Professional | | $0.58 | $0.87 | $1.62 |
- 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
- $4.57 / $6.76 / $6.76
| Professional | | $4.57 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $32.36 / $33.11
| Professional | | $0.89 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.91 / $1.23
| Facility | | $0.26 | $0.91 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.87
| Professional | | $0.46 | $0.46 | $0.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.70
| Professional | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.74 / $0.83
| Professional | | $0.74 | $0.74 | $0.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.35 / $0.42
| Facility | | $0.24 | $0.35 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.40 / $0.98
| Professional | | $0.34 | $0.40 | $0.98 |