- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Professional | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $38.02
| Professional | | $15.14 | $15.85 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.14 / $0.39
| Facility | | $0.10 | $0.14 | $0.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $0.07
| Professional | | $0.07 | $0.07 | $0.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.39 / $0.39
| Professional | | $0.33 | $0.39 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $3.63
| Facility | | $3.63 | $3.63 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $0.51
| Facility | | $0.07 | $0.07 | $0.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.06 / $0.06
| Professional | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $2.82 / $5.37
| Professional | | $2.82 | $2.82 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.28 / $0.55
| Facility | | $0.12 | $0.28 | $0.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.14 / $1.00
| Professional | | $0.11 | $0.14 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.28 / $0.56
| Facility | | $0.12 | $0.28 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.06 / $0.06 / $0.06
| Professional | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.06 / $0.09
| Facility | | $0.05 | $0.06 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.07 / $0.09
| Professional | | $0.05 | $0.07 | $0.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.05 / $0.05 / $0.05
| Professional | | $0.05 | $0.05 | $0.05 |