- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $9.55 / $87.10
| Facility | | $3.09 | $9.55 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $3.47 / $18.20
| Professional | | $1.20 | $3.47 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.47 / $1.45
| Facility | | $0.24 | $0.47 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.24 / $0.38
| Professional | | $0.22 | $0.24 | $0.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Facility | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $0.21
| Facility | | $0.21 | $0.21 | $0.21 |
- 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
- $0.42 / $0.47 / $0.74
| Facility | | $0.42 | $0.47 | $0.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.22 / $0.22
| Professional | | $0.22 | $0.22 | $0.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $1.17 / $5.13
| Facility | | $0.30 | $1.17 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.68
| Professional | | $0.18 | $0.18 | $0.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.23 / $0.29
| Professional | | $0.18 | $0.23 | $0.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.37 / $0.51
| Professional | | $0.21 | $0.37 | $0.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.27 / $0.47 / $0.47
| Facility | | $0.27 | $0.47 | $0.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.23
| Professional | | $0.18 | $0.18 | $0.23 |