- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $7.24 / $93.33
| Facility | | $2.00 | $7.24 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.20 / $3.80
| Professional | | $1.00 | $1.20 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.12 / $1.66
| Facility | | $1.02 | $1.12 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.98 / $1.12 / $3.09
| Professional | | $0.98 | $1.12 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.75
| Facility | | $2.24 | $2.24 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.51 / $3.31
| Professional | | $1.17 | $1.51 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.62 / $2.19
| Facility | | $1.00 | $1.62 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $0.95 / $0.95
| Professional | | $0.95 | $0.95 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $1.20 / $3.02
| Professional | | $0.85 | $1.20 | $3.02 |
- 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
- $1.02 / $1.02 / $1.02
| Professional | | $1.02 | $1.02 | $1.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.55 / $2.40
| Facility | | $0.95 | $1.55 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $0.95 / $1.32
| Professional | | $0.95 | $0.95 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $1.05 / $1.62
| Professional | | $0.76 | $1.05 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Facility | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.12 / $2.63
| Professional | | $1.07 | $1.12 | $2.63 |