- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $77.62 / $257.04
| Facility | | $40.74 | $77.62 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $63.10
| Professional | | $1.00 | $1.00 | $63.10 |
- 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 / $0.03 / $0.04
| Professional | | $0.03 | $0.03 | $0.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.09 / $0.13
| Facility | | $0.04 | $0.09 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.05 / $0.08
| Professional | | $0.03 | $0.05 | $0.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.71
| Facility | | $0.04 | $0.04 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.08 / $0.08
| Professional | | $0.06 | $0.08 | $0.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.48 / $1.10
| Facility | | $0.05 | $0.48 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.08
| Professional | | $0.05 | $0.05 | $0.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $85.11
| Professional | | $64.57 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.06 / $0.06
| Facility | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.05 / $1.00
| Professional | | $0.03 | $0.05 | $1.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $100.00
| Facility | | $0.04 | $0.04 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.04
| Professional | | $0.04 | $0.04 | $0.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.17
| Professional | | $0.04 | $0.04 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.12
| Facility | | $0.05 | $0.05 | $0.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.06
| Professional | | $0.04 | $0.04 | $0.06 |