- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.35 / $112.20
| Facility | | $1.00 | $1.35 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.38 / $1.38
| Professional | | $1.20 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.50 / $0.68
| Professional | | $0.49 | $0.50 | $0.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.50 / $50,118.72
| Facility | | $0.49 | $0.50 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $2.14
| Professional | | $0.50 | $0.50 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.47 / $0.62 / $1.70
| Facility | | $0.47 | $0.62 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $0.51 / $0.63
| Professional | | $0.51 | $0.51 | $0.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $0.52
| Facility | | $0.50 | $0.50 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $0.52
| Professional | | $0.50 | $0.50 | $0.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $50,118.72 / $75,857.76
| Facility | | $0.65 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.55 / $0.55 / $0.55
| Facility | | $0.55 | $0.55 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.44 / $0.50 / $1.26
| Professional | | $0.44 | $0.50 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $0.59
| Facility | | $0.50 | $0.50 | $0.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.50 / $0.60
| Professional | | $0.24 | $0.50 | $0.60 |