- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $18.20
| Facility | | $1.00 | $1.00 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.41
| Professional | | $1.00 | $1.00 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $67.61 / $81.28
| Professional | | $2.29 | $67.61 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.70 / $4.47
| Facility | | $1.29 | $1.70 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.78 / $0.78
| Professional | | $0.78 | $0.78 | $0.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.10
| Facility | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.98 / $0.98 / $2.57
| Facility | | $0.98 | $0.98 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $0.81
| Professional | | $0.81 | $0.81 | $0.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $12.02 / $12.02
| Professional | | $8.13 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.98 / $1.48 / $2.40
| Facility | | $0.98 | $1.48 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.74
| Professional | | $1.00 | $1.00 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.15 / $1.32
| Professional | | $1.15 | $1.15 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.51 / $3.24
| Professional | | $2.19 | $2.51 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.41 / $2.40
| Facility | | $0.95 | $1.41 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $0.81
| Professional | | $0.81 | $0.81 | $0.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.47 / $0.66 / $1.00
| Facility | | $0.47 | $0.66 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.76 / $1.00
| Professional | | $0.56 | $0.76 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.62 / $1.62
| Professional | | $1.48 | $1.62 | $1.62 |