- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $380.19 / $501.19
| Facility | | $1.12 | $380.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $10.00
| Professional | | $1.12 | $1.12 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.65
| Facility | | $0.65 | $0.65 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $0.51 / $0.65
| Professional | | $0.51 | $0.51 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $1.35 / $2.00
| Facility | | $0.68 | $1.35 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.38 / $0.51 / $0.68
| Professional | | $0.38 | $0.51 | $0.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.39 / $1.32
| Facility | | $0.39 | $0.39 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.78 / $1.58
| Professional | | $0.59 | $0.78 | $1.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $6.61
| Facility | | $0.37 | $0.37 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $0.78
| Professional | | $0.37 | $0.37 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $64.57 / $85.11
| Professional | | $0.37 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.74 / $0.74
| Facility | | $0.74 | $0.74 | $0.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $0.52 / $1.55
| Professional | | $0.51 | $0.52 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $100.00
| Facility | | $0.37 | $0.37 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $0.37
| Professional | | $0.37 | $0.37 | $0.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $0.69 / $1.82
| Professional | | $0.69 | $0.69 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.45 / $0.45 / $1.05
| Facility | | $0.45 | $0.45 | $1.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.37 / $0.52
| Professional | | $0.37 | $0.37 | $0.52 |