- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $295.12 / $891.25
| Facility | | $1.15 | $295.12 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.23 / $1.23
| Professional | | $1.23 | $1.23 | $1.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.60 / $1.23
| Facility | | $0.25 | $0.60 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.25
| Professional | | $0.25 | $0.25 | $0.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.37 / $1.07
| Facility | | $0.25 | $0.37 | $1.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.30
| Professional | | $0.25 | $0.25 | $0.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $75.86
| Professional | | $50.12 | $50.12 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.52 / $0.78
| Facility | | $0.28 | $0.52 | $0.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.65 / $1.23
| Facility | | $0.36 | $0.65 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.45 / $0.45
| Professional | | $0.32 | $0.45 | $0.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.60 / $1.23
| Facility | | $0.40 | $0.60 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.25
| Professional | | $0.25 | $0.25 | $0.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.25
| Facility | | $0.25 | $0.25 | $0.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.27 / $0.37
| Professional | | $0.25 | $0.27 | $0.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.33
| Professional | | $0.25 | $0.25 | $0.33 |