- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.29 / $263.03
| Facility | | $1.07 | $1.29 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $2.29 / $2.29
| Professional | | $1.48 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Facility | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Professional | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $2.82
| Facility | | $0.81 | $0.81 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.76
| Professional | | $0.62 | $0.62 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $75.86
| Professional | | $64.57 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.65 / $1.32
| Facility | | $0.63 | $0.65 | $1.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.48 / $1.48
| Facility | | $0.93 | $1.48 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.93 / $0.93
| Professional | | $0.68 | $0.93 | $0.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Facility | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Professional | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $1.41
| Facility | | $0.60 | $0.60 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.62 / $0.62
| Professional | | $0.60 | $0.62 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.79
| Professional | | $0.62 | $0.62 | $0.79 |