- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $9.77 / $87.10
| Facility | | $3.55 | $9.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.82 / $5.62
| Professional | | $1.05 | $1.82 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $1.82 / $5.50
| Facility | | $0.91 | $1.82 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.00 / $1.62
| Professional | | $0.85 | $1.00 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $1.12
| Facility | | $1.12 | $1.12 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Facility | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.07 / $1.07
| Professional | | $1.07 | $1.07 | $1.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.82 / $2.82
| Facility | | $1.58 | $1.82 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $0.85
| Professional | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $3.98 / $19.05
| Facility | | $0.87 | $3.98 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.83 / $2.09
| Professional | | $0.83 | $0.83 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $1.15 / $1.66
| Professional | | $0.87 | $1.15 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $1.45 / $1.95
| Professional | | $0.79 | $1.45 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.78 / $1.78
| Facility | | $1.00 | $1.78 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $0.83 / $0.89
| Professional | | $0.83 | $0.83 | $0.89 |