- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $2.24
| Facility | | $1.91 | $1.91 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $3.63 / $3.63
| Professional | | $1.91 | $3.63 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $3.55
| Facility | | $0.12 | $0.12 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.17 / $0.58
| Facility | | $0.17 | $0.17 | $0.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.15
| Professional | | $0.12 | $0.12 | $0.15 |
- 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
- $0.17 / $0.27 / $0.51
| Facility | | $0.17 | $0.27 | $0.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.28 / $0.28
| Facility | | $0.20 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.20 / $0.20
| Professional | | $0.18 | $0.20 | $0.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $3.55
| Facility | | $0.12 | $0.12 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.15 / $0.35
| Facility | | $0.15 | $0.15 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.16 / $0.16
| Professional | | $0.15 | $0.16 | $0.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.16 / $0.16
| Professional | | $0.12 | $0.16 | $0.16 |