- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $158.49 / $158.49
| Facility | | $3.02 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $4.68 / $8.13
| Professional | | $1.05 | $4.68 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.30 / $0.91
| Facility | | $0.15 | $0.30 | $0.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.15 / $0.24
| Professional | | $0.14 | $0.15 | $0.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $1.20
| Facility | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.22
| Facility | | $0.19 | $0.19 | $0.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.26
| Professional | | $0.19 | $0.19 | $0.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.28 / $0.46
| Facility | | $0.26 | $0.28 | $0.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $0.26
| Professional | | $0.14 | $0.14 | $0.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.15 / $85.11
| Facility | | $0.14 | $0.15 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.15 / $0.41
| Professional | | $0.15 | $0.15 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.19 / $0.24
| Professional | | $0.15 | $0.19 | $0.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.17 / $0.26
| Professional | | $0.13 | $0.17 | $0.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.43 / $0.43
| Facility | | $0.24 | $0.43 | $0.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.15 / $0.20
| Professional | | $0.15 | $0.15 | $0.20 |