- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $616.60
| Facility | | $39.81 | $79.43 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $61.66 / $407.38
| Professional | | $15.14 | $61.66 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $22.91
| Professional | | $19.05 | $19.05 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Facility | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.17 / $0.17
| Professional | | $0.15 | $0.17 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.22 / $0.68
| Facility | | $0.22 | $0.22 | $0.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.15 / $0.16
| Professional | | $0.15 | $0.15 | $0.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.15 / $0.71
| Facility | | $0.10 | $0.15 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.15 / $0.71
| Professional | | $0.10 | $0.15 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $70.79 / $79.43
| Professional | | $30.20 | $70.79 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.15 / $0.28
| Facility | | $0.14 | $0.15 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.33 / $0.33
| Facility | | $0.16 | $0.33 | $0.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.16 / $0.16
| Professional | | $0.14 | $0.16 | $0.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Facility | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.17 / $0.17
| Professional | | $0.15 | $0.17 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.08 / $0.13 / $0.31
| Facility | | $0.08 | $0.13 | $0.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.11 / $0.14
| Professional | | $0.10 | $0.11 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.15 / $0.20
| Professional | | $0.10 | $0.15 | $0.20 |