- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $6.17 / $95.50
| Facility | | $1.45 | $6.17 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.82 / $4.37
| Professional | | $1.00 | $2.82 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.87 / $1.12
| Facility | | $0.78 | $0.87 | $1.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.79 / $4.17
| Professional | | $0.72 | $0.79 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.09 / $3.72
| Facility | | $2.00 | $3.09 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.95 / $2.82
| Professional | | $0.72 | $0.95 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $1.35 / $1.82
| Facility | | $0.81 | $1.35 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.81
| Professional | | $0.79 | $0.79 | $0.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $0.81 / $6.03
| Professional | | $0.66 | $0.81 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $1.20
| Professional | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $1.45 / $2.51
| Facility | | $0.79 | $1.45 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $2.34
| Professional | | $0.79 | $0.79 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.62 / $1.62
| Professional | | $1.62 | $1.62 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.87 / $1.35
| Professional | | $0.63 | $0.87 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $2.82
| Facility | | $2.82 | $2.82 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.78 / $2.40
| Professional | | $0.72 | $0.78 | $2.40 |