- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $24.55 / $79.43
| Facility | | $2.45 | $24.55 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.38 / $2.57
| Professional | | $1.00 | $1.38 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.29 / $3.89
| Facility | | $0.65 | $1.29 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.19 / $1.12
| Professional | | $0.15 | $0.19 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.59 / $0.62
| Facility | | $0.59 | $0.59 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.51 / $1.74
| Facility | | $1.29 | $1.51 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.71
| Professional | | $0.60 | $0.60 | $0.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $3.80 / $15.49
| Facility | | $0.72 | $3.80 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $0.87 / $1.29
| Professional | | $0.87 | $0.87 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.48 / $0.56
| Professional | | $0.39 | $0.48 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.87 / $1.48
| Professional | | $0.65 | $0.87 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.39 / $3.39
| Facility | | $1.95 | $3.39 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.79
| Professional | | $0.60 | $0.60 | $0.79 |