- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.29 / $1.29
| Facility | | $1.29 | $1.29 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $4.17 / $4.17
| Professional | | $1.00 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $1.07
| Professional | | $0.81 | $0.81 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.49 / $0.49
| Professional | | $0.49 | $0.49 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $1.10 / $1.66
| Facility | | $0.46 | $1.10 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $1.15 / $1.62
| Professional | | $0.46 | $1.15 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.93 / $0.95
| Facility | | $0.74 | $0.93 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.95 / $1.05
| Professional | | $0.83 | $0.95 | $1.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $1.48 / $1.82
| Facility | | $0.79 | $1.48 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.91
| Professional | | $0.79 | $0.79 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.81 / $1.07
| Professional | | $0.78 | $0.81 | $1.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.31 / $0.31 / $0.76
| Facility | | $0.31 | $0.31 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.41 / $0.78
| Professional | | $0.36 | $0.41 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $1.45
| Professional | | $0.81 | $0.81 | $1.45 |