- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.24
| Professional | | $2.24 | $2.24 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.46 / $1.32
| Facility | | $0.24 | $0.46 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.24 / $0.27
| Professional | | $0.24 | $0.24 | $0.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.41 / $0.63
| Professional | | $0.32 | $0.41 | $0.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $0.51 / $79.43
| Facility | | $0.51 | $0.51 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.31 / $0.31 / $0.39
| Facility | | $0.31 | $0.31 | $0.39 |
- 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
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $3.72
| Professional | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.44 / $0.78
| Facility | | $0.26 | $0.44 | $0.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.46 / $1.02
| Professional | | $0.18 | $0.46 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $2,754.23
| Professional | | $81.28 | $81.28 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.27 / $0.43 / $0.74
| Facility | | $0.27 | $0.43 | $0.74 |
- 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
- $0.17 / $0.23 / $0.33
| Facility | | $0.17 | $0.23 | $0.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.25 / $0.32
| Professional | | $0.19 | $0.25 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $0.51 / $0.51
| Professional | | $0.24 | $0.51 | $0.51 |