- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $15.14 / $87.10
| Facility | | $1.29 | $15.14 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.17 / $0.46 / $1.29
| Professional | | $0.17 | $0.46 | $1.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $61.66
| Professional | | $16.98 | $28.18 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.24 / $0.30
| Facility | | $0.21 | $0.24 | $0.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.21 / $0.58
| Professional | | $0.20 | $0.21 | $0.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.41 / $0.52
| Facility | | $0.41 | $0.41 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.22 / $0.41
| Professional | | $0.20 | $0.22 | $0.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.37 / $0.49
| Facility | | $0.21 | $0.37 | $0.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $0.41
| Professional | | $0.21 | $0.21 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.20 / $0.21
| Professional | | $0.16 | $0.20 | $0.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.21 / $0.45
| Professional | | $0.18 | $0.21 | $0.45 |
- 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
- $0.19 / $0.19 / $0.19
| Professional | | $0.19 | $0.19 | $0.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.21 / $0.49
| Facility | | $0.20 | $0.21 | $0.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $0.41
| Professional | | $0.21 | $0.21 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.22 / $0.22
| Professional | | $0.22 | $0.22 | $0.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.42 / $0.42
| Facility | | $0.02 | $0.42 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.20 / $0.54
| Professional | | $0.13 | $0.20 | $0.54 |