- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $34.67 / $34.67
| Facility | | $7.08 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.30 / $0.91
| Professional | | $0.09 | $0.30 | $0.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.10
| Facility | | $0.09 | $0.09 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.10
| Professional | | $0.09 | $0.09 | $0.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.11 / $0.39
| Facility | | $0.11 | $0.11 | $0.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.11
| Professional | | $0.09 | $0.09 | $0.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $75.86
| Professional | | $64.57 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.19
| Facility | | $0.09 | $0.09 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $1.26 / $4.68
| Facility | | $0.13 | $1.26 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.13 / $0.16
| Professional | | $0.10 | $0.13 | $0.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.10
| Facility | | $0.09 | $0.09 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.09 / $0.09 / $0.10
| Professional | | $0.09 | $0.09 | $0.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.04 / $0.04 / $0.09
| Facility | | $0.04 | $0.04 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.08 / $0.09
| Professional | | $0.08 | $0.08 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.09 / $0.12
| Professional | | $0.08 | $0.09 | $0.12 |