- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $3.09 / $251.19
| Facility | | $1.32 | $3.09 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.09 / $4.47
| Professional | | $1.00 | $2.09 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $1.12
| Professional | | $1.12 | $1.12 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.45 / $1.48
| Facility | | $1.12 | $1.45 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.45 / $1.48
| Professional | | $1.41 | $1.45 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.02 / $1.02
| Facility | | $1.02 | $1.02 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.35 / $1.70
| Professional | | $1.29 | $1.35 | $1.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $47.86 / $102.33
| Facility | | $2.63 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.35 / $1.35
| Professional | | $1.26 | $1.35 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.51 / $1.51
| Professional | | $1.51 | $1.51 | $1.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.51 / $3.31
| Facility | | $1.26 | $1.51 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.32 / $1.32
| Professional | | $1.23 | $1.32 | $1.32 |