- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.66 / $89.13
| Facility | | $1.17 | $1.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $2.14 / $2.14
| Professional | | $1.38 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Facility | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.07 / $3.55
| Facility | | $1.07 | $1.07 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.98
| Professional | | $0.79 | $0.79 | $0.98 |
- 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
- $0.83 / $0.93 / $1.74
| Facility | | $0.83 | $0.93 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $0.58 / $0.69
| Facility | | $0.58 | $0.58 | $0.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.69 / $0.69 / $0.71
| Professional | | $0.69 | $0.69 | $0.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Facility | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $0.79
| Professional | | $0.79 | $0.79 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.71 / $1.66
| Facility | | $0.71 | $0.71 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.79 / $0.79
| Professional | | $0.71 | $0.79 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $0.79 / $1.05
| Professional | | $0.79 | $0.79 | $1.05 |