- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $41.69 / $162.18
| Facility | | $1.05 | $41.69 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $2.09 / $10.96
| Professional | | $1.05 | $2.09 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.56 / $1.70
| Facility | | $0.28 | $0.56 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.30 / $0.49
| Professional | | $0.26 | $0.30 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.35
| Facility | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.26
| Facility | | $0.26 | $0.26 | $0.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.35
| Professional | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.48 / $0.54 / $0.83
| Facility | | $0.48 | $0.54 | $0.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.65
| Professional | | $0.26 | $0.26 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.25 / $2.88
| Facility | | $0.23 | $0.25 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $1.26
| Professional | | $0.25 | $0.25 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.31 / $0.36
| Professional | | $0.25 | $0.31 | $0.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.44 / $0.60
| Professional | | $0.24 | $0.44 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.60 / $0.60
| Facility | | $0.34 | $0.60 | $0.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.28
| Professional | | $0.25 | $0.25 | $0.28 |