- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $20.89
| Facility | | $3.39 | $3.39 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $3.39 / $3.39
| Professional | | $1.55 | $3.39 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.37 / $0.91
| Facility | | $0.28 | $0.37 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.38 / $0.38 / $1.12
| Professional | | $0.38 | $0.38 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $1.10 / $1.66
| Facility | | $0.81 | $1.10 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.45 / $2.95
| Professional | | $0.89 | $1.45 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.40 / $0.40
| Professional | | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.87 / $1.07
| Professional | | $0.79 | $0.87 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $1.00 / $104.71
| Professional | | $0.72 | $1.00 | $104.71 |
- 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
- $3.98 / $5.89 / $5.89
| Professional | | $3.98 | $5.89 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $1.12
| Professional | | $1.12 | $1.12 | $1.12 |
- 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
- $0.46 / $0.79 / $1.10
| Facility | | $0.46 | $0.79 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.40 / $0.76
| Professional | | $0.40 | $0.40 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.55 / $0.66 / $0.93
| Professional | | $0.55 | $0.66 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.35 / $0.79
| Professional | | $0.30 | $0.35 | $0.79 |