- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $8.13 / $58.88
| Facility | | $0.25 | $8.13 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $2.00 / $3.02
| Professional | | $1.26 | $2.00 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.56 / $1.70
| Facility | | $0.28 | $0.56 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.32 / $0.49
| Professional | | $0.26 | $0.32 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $3.39
| Facility | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.24 / $0.24
| Facility | | $0.24 | $0.24 | $0.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $0.32
| Professional | | $0.32 | $0.32 | $0.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.56 / $0.87
| Facility | | $0.50 | $0.56 | $0.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.31
| Professional | | $0.26 | $0.26 | $0.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.24 / $0.81
| Facility | | $0.24 | $0.24 | $0.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.35
| Professional | | $0.26 | $0.26 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.33 / $0.52
| Professional | | $0.25 | $0.33 | $0.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.31 / $0.35 / $0.62
| Facility | | $0.31 | $0.35 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.31
| Professional | | $0.26 | $0.26 | $0.31 |