- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.78 / $53.70
| Facility | | $1.41 | $1.78 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.41 / $3.89
| Professional | | $1.00 | $1.41 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $1.51 / $5.75
| Facility | | $0.76 | $1.51 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.76 / $0.76
| Professional | | $0.68 | $0.76 | $0.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.02 / $3.09
| Facility | | $0.89 | $1.02 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.95
| Professional | | $0.68 | $0.68 | $0.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.98 / $21.38
| Facility | | $0.68 | $0.98 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.95 / $21.38
| Professional | | $0.68 | $0.95 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $70.79 / $79.43
| Professional | | $30.20 | $70.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $1.00 / $2.09
| Facility | | $0.87 | $1.00 | $2.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $2.04 / $3.98
| Facility | | $1.20 | $2.04 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.19
| Professional | | $2.19 | $2.19 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.55 / $5.50
| Facility | | $0.95 | $1.55 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.76 / $0.76
| Professional | | $0.68 | $0.76 | $0.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.95
| Facility | | $0.68 | $0.68 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.05 / $1.55
| Professional | | $0.89 | $1.05 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.89
| Professional | | $0.68 | $0.68 | $0.89 |