- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $7.24 / $42.66
| Facility | | $2.00 | $7.24 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.37 / $2.51
| Professional | | $0.13 | $0.37 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $0.27
| Professional | | $0.21 | $0.21 | $0.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.31 / $0.47
| Professional | | $0.21 | $0.31 | $0.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.41 / $0.52
| Facility | | $0.30 | $0.41 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $0.41
| Professional | | $0.21 | $0.21 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.21 / $1.95
| Professional | | $0.15 | $0.21 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $2.88
| Professional | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.21 / $0.23
| Facility | | $0.20 | $0.21 | $0.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.21 / $0.23
| Professional | | $0.20 | $0.21 | $0.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.28 / $0.46
| Facility | | $0.20 | $0.28 | $0.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.28 / $0.46
| Professional | | $0.20 | $0.28 | $0.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.19 / $1.55
| Facility | | $0.08 | $0.19 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.20 / $0.22
| Professional | | $0.15 | $0.20 | $0.22 |