- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $11.75 / $95.50
| Facility | | $5.25 | $11.75 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $8.13 / $25.70
| Professional | | $1.51 | $8.13 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.19 / $0.59
| Facility | | $0.10 | $0.19 | $0.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.10 / $0.17
| Professional | | $0.09 | $0.10 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Facility | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.09
| Facility | | $0.09 | $0.09 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.19 / $0.32
| Facility | | $0.18 | $0.19 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.11
| Professional | | $0.09 | $0.09 | $0.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.62 / $2.29
| Facility | | $0.17 | $0.62 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.20
| Professional | | $0.09 | $0.09 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.11 / $0.13
| Professional | | $0.09 | $0.11 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.15 / $0.21
| Professional | | $0.08 | $0.15 | $0.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.19 / $0.19
| Facility | | $0.11 | $0.19 | $0.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.10
| Professional | | $0.09 | $0.09 | $0.10 |