- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $58.88 / $112.20
| Facility | | $4.27 | $58.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $6.61 / $83.18
| Professional | | $0.60 | $6.61 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.05 / $0.10
| Facility | | $0.02 | $0.05 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.05 / $0.07
| Professional | | $0.02 | $0.05 | $0.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.33 / $52.48
| Facility | | $0.07 | $0.33 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.05 / $0.05
| Professional | | $0.03 | $0.05 | $0.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $7.08
| Facility | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.05 / $0.14
| Facility | | $0.02 | $0.05 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $100.00
| Facility | | $85.11 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.04 / $87.10
| Facility | | $0.03 | $0.04 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $5.01 / $28.84
| Professional | | $0.03 | $5.01 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.03 / $0.07
| Facility | | $0.02 | $0.03 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.05 / $0.05
| Facility | | $0.04 | $0.05 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |