- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $23.44 / $95.50
| Facility | | $5.50 | $23.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $8.91 / $51.29
| Professional | | $4.17 | $8.91 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.11 / $0.33
| Facility | | $0.05 | $0.11 | $0.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.09
| Professional | | $0.05 | $0.05 | $0.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $0.07
| Facility | | $0.07 | $0.07 | $0.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.05
| Facility | | $0.05 | $0.05 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $0.07
| Professional | | $0.07 | $0.07 | $0.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.09 / $0.14
| Facility | | $0.08 | $0.09 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.08
| Professional | | $0.05 | $0.05 | $0.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.24 / $0.95
| Facility | | $0.05 | $0.24 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.17
| Professional | | $0.05 | $0.05 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.06 / $0.07
| Professional | | $0.05 | $0.06 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.08 / $0.12
| Professional | | $0.05 | $0.08 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.13 / $0.13
| Facility | | $0.07 | $0.13 | $0.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.07
| Professional | | $0.05 | $0.05 | $0.07 |