- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $3.55 / $245.47
| Facility | | $1.07 | $3.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $3.63 / $67.61
| Professional | | $1.07 | $3.63 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.85
| Professional | | $15.14 | $15.14 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.17 / $0.42
| Facility | | $0.16 | $0.17 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.19 / $0.40
| Professional | | $0.16 | $0.19 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.18
| Professional | | $0.18 | $0.18 | $0.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.35 / $0.46
| Facility | | $0.22 | $0.35 | $0.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.16 / $0.18
| Professional | | $0.16 | $0.16 | $0.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.33 / $1.07
| Facility | | $0.23 | $0.33 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.25 / $154.88
| Professional | | $0.23 | $0.25 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.41
| Facility | | $0.35 | $0.35 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.17 / $4.07
| Professional | | $0.15 | $0.17 | $4.07 |