- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $9.55 / $87.10
| Facility | | $1.48 | $9.55 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $4.79 / $16.60
| Professional | | $1.15 | $4.79 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $74.13 / $89.13
| Professional | | $1.66 | $74.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.98 / $1.29
| Facility | | $0.78 | $0.98 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.87 / $5.13
| Professional | | $0.74 | $0.87 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $2.34
| Facility | | $1.82 | $1.82 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.57 / $5.13
| Professional | | $2.04 | $2.57 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $1.51 / $2.04
| Facility | | $0.91 | $1.51 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.93
| Professional | | $0.89 | $0.89 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.89 / $2.04
| Professional | | $0.68 | $0.89 | $2.04 |
- 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
- $1.38 / $2.19 / $5.13
| Professional | | $1.38 | $2.19 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $0.89
| Professional | | $0.89 | $0.89 | $0.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $1.58 / $2.40
| Facility | | $0.89 | $1.58 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $1.95
| Professional | | $0.89 | $0.89 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $2.34
| Professional | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.98 / $1.51
| Professional | | $0.72 | $0.98 | $1.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $5.13
| Facility | | $5.13 | $5.13 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $0.74 / $2.09
| Professional | | $0.74 | $0.74 | $2.09 |