- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $1.48
| Facility | | $1.48 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.48 / $1.48
| Professional | | $1.29 | $1.48 | $1.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.15 / $0.38
| Facility | | $0.12 | $0.15 | $0.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.16 / $0.39
| Professional | | $0.14 | $0.16 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.37 / $0.49 / $0.74
| Facility | | $0.37 | $0.49 | $0.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.39 / $0.62 / $1.26
| Professional | | $0.39 | $0.62 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.17
| Professional | | $0.17 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.39 / $0.47
| Professional | | $0.35 | $0.39 | $0.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.44 / $125.89
| Professional | | $0.32 | $0.44 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.50 / $0.50
| Professional | | $0.50 | $0.50 | $0.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.35 / $0.50
| Facility | | $0.19 | $0.35 | $0.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.33
| Professional | | $0.17 | $0.17 | $0.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.63 / $0.63
| Professional | | $0.63 | $0.63 | $0.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.34 / $0.52
| Professional | | $0.28 | $0.34 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.16 / $0.35
| Professional | | $0.13 | $0.16 | $0.35 |