- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $58.88 / $186.21
| Facility | | $12.02 | $58.88 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $7.94 / $32.36
| Professional | | $0.08 | $7.94 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | | $0.02 | $0.02 | $0.02 |
- 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
- $0.03 / $0.03 / $0.09
| Facility | | $0.03 | $0.03 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $75.86
| Professional | | $64.57 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.03 / $0.06
| Facility | | $0.03 | $0.03 | $0.06 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.04
| Facility | | $0.04 | $0.04 | $0.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.04 / $0.04
| Professional | | $0.03 | $0.04 | $0.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | | $0.02 | $0.02 | $0.02 |
- 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
- $0.03 / $0.03 / $0.07
| Facility | | $0.03 | $0.03 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |