- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $87.10 / $239.88
| Facility | | $19.05 | $87.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $316.23
| Professional | | $58.88 | $91.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.65 / $1.95
| Facility | | $0.32 | $0.65 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.36 / $0.56
| Professional | | $0.30 | $0.36 | $0.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.36 / $0.36
| Facility | | $0.36 | $0.36 | $0.36 |
- 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 / $0.38 / $0.66
| Professional | | $0.28 | $0.38 | $0.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $0.65 / $1.02
| Facility | | $0.58 | $0.65 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.59
| Professional | | $0.30 | $0.30 | $0.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.91 / $5.89
| Facility | | $0.26 | $0.91 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.27 / $0.27 / $0.66
| Professional | | $0.27 | $0.27 | $0.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.35 / $0.58
| Professional | | $0.28 | $0.35 | $0.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.59 / $0.87
| Professional | | $0.32 | $0.59 | $0.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.56 / $0.71
| Facility | | $0.32 | $0.56 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.28 / $0.35
| Professional | | $0.26 | $0.28 | $0.35 |