- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $7.59 / $91.20
| Facility | | $1.12 | $7.59 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.71 / $1.70
| Professional | | $0.19 | $0.71 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.44 / $0.44 / $0.56
| Professional | | $0.44 | $0.44 | $0.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.45 / $0.62 / $0.91
| Professional | | $0.45 | $0.62 | $0.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.54 / $0.83 / $1.10
| Facility | | $0.54 | $0.83 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.44 / $0.44 / $0.54
| Professional | | $0.44 | $0.44 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.44 / $3.09
| Professional | | $0.30 | $0.44 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Professional | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.42 / $0.44
| Facility | | $0.36 | $0.42 | $0.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.42 / $0.46
| Professional | | $0.40 | $0.42 | $0.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.42 / $0.52 / $0.65
| Facility | | $0.42 | $0.52 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.42 / $0.52 / $0.65
| Professional | | $0.42 | $0.52 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.36 / $2.63
| Facility | | $0.14 | $0.36 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.40 / $0.44
| Professional | | $0.30 | $0.40 | $0.44 |