- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Professional | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.18
| Professional | | $0.18 | $0.18 | $0.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.27 / $0.48
| Facility | | $0.15 | $0.27 | $0.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.18 / $0.19
| Professional | | $0.15 | $0.18 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.20 / $0.20
| Facility | | $0.16 | $0.20 | $0.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.16 / $0.20
| Facility | | $0.05 | $0.16 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.20
| Professional | | $0.17 | $0.17 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $54.95 / $85.11
| Professional | | $50.12 | $54.95 | $85.11 |
- 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
- $0.17 / $0.17 / $85.11
| Facility | | $0.17 | $0.17 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Professional | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $1.51
| Professional | | $0.81 | $0.81 | $1.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.10 / $0.23
| Facility | | $0.10 | $0.10 | $0.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.23
| Professional | | $0.18 | $0.18 | $0.23 |