- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.20 / $1.91
| Facility | | $1.12 | $1.20 | $1.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $2.04 / $3.09
| Professional | | $1.15 | $2.04 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.66 / $1.35
| Facility | | $0.59 | $0.66 | $1.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.58 / $1.91
| Professional | | $0.56 | $0.58 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.47 / $1.95
| Facility | | $0.40 | $0.47 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.72 / $1.78
| Professional | | $0.56 | $0.72 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.98 / $1.32
| Facility | | $0.59 | $0.98 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $0.56
| Professional | | $0.56 | $0.56 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $0.62 / $3.02
| Professional | | $0.51 | $0.62 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.63 / $0.63
| Professional | | $0.63 | $0.63 | $0.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $1.00 / $1.51
| Facility | | $0.56 | $1.00 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $1.23
| Professional | | $0.56 | $0.56 | $1.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.45 / $2.45
| Professional | | $2.45 | $2.45 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.63 / $0.98
| Professional | | $0.46 | $0.63 | $0.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $5.50
| Facility | | $5.50 | $5.50 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $1.51
| Professional | | $0.56 | $0.56 | $1.51 |