- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $5.25 / $89.13
| Facility | | $1.55 | $5.25 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.41 / $3.09
| Professional | | $1.00 | $1.41 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $1.66
| Facility | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $7.41
| Facility | | $2.19 | $2.19 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $2.04
| Professional | | $1.66 | $1.66 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $75.86
| Professional | | $64.57 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.55 / $2.88
| Facility | | $1.38 | $1.55 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.41 / $1.41
| Facility | | $1.38 | $1.41 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.38 / $1.45
| Professional | | $1.38 | $1.38 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $1.66
| Facility | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $3.72
| Facility | | $1.58 | $1.58 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.48 / $1.70
| Professional | | $1.41 | $1.48 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $2.14
| Professional | | $1.66 | $1.66 | $2.14 |