- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Facility | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $100.00 / $257.04
| Professional | | $1.29 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Facility | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.28 / $0.49
| Facility | | $0.24 | $0.28 | $0.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $1.26
| Professional | | $0.28 | $0.28 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.35 / $0.91
| Facility | | $0.24 | $0.35 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.24 / $0.32
| Professional | | $0.24 | $0.24 | $0.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.32
| Facility | | $0.30 | $0.30 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.30
| Professional | | $0.30 | $0.30 | $0.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $50,118.72 / $75,857.76
| Facility | | $0.37 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.48
| Facility | | $0.28 | $0.28 | $0.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.31 / $0.87
| Professional | | $0.28 | $0.31 | $0.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.34
| Facility | | $0.30 | $0.30 | $0.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.36
| Professional | | $0.30 | $0.30 | $0.36 |