- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $8.71 / $87.10
| Facility | | $2.75 | $8.71 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $7.08 / $29.51
| Professional | | $0.68 | $7.08 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.28
| Facility | | $0.20 | $0.20 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.19 / $5,011.87
| Facility | | $0.16 | $0.19 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.78 / $0.83
| Facility | | $0.22 | $0.78 | $0.83 |
- 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
- $0.22 / $0.22 / $0.22
| Facility | | $0.22 | $0.22 | $0.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.38 / $0.38
| Professional | | $0.33 | $0.38 | $0.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $3.09 / $7.08
| Facility | | $0.52 | $3.09 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.28
| Facility | | $0.20 | $0.20 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $7.59 / $194.98
| Facility | | $1.07 | $7.59 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.15 / $0.24
| Facility | | $0.11 | $0.15 | $0.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.15 / $0.24
| Professional | | $0.11 | $0.15 | $0.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.33
| Professional | | $0.18 | $0.18 | $0.33 |