- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Facility | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $4.17
| Professional | | $1.00 | $1.00 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $1.00 / $2.69
| Facility | | $0.76 | $1.00 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.46
| Professional | | $0.46 | $0.46 | $0.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $0.58 / $1.51
| Facility | | $0.58 | $0.58 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.49 / $0.49
| Professional | | $0.49 | $0.49 | $0.49 |
- 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
- $4.79 / $7.08 / $7.08
| Professional | | $4.79 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.87 / $1.45
| Facility | | $0.56 | $0.87 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.91 / $1.51
| Professional | | $0.59 | $0.91 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.51 / $1.91
| Professional | | $1.29 | $1.51 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.83 / $1.45
| Facility | | $0.56 | $0.83 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $0.49 / $0.49
| Professional | | $0.49 | $0.49 | $0.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.27 / $0.38 / $0.56
| Facility | | $0.27 | $0.38 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.43 / $0.56
| Professional | | $0.34 | $0.43 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $0.98 / $0.98
| Professional | | $0.87 | $0.98 | $0.98 |