- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.62
| Facility | | $0.62 | $0.62 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $3.02 / $3.02
| Professional | | $1.70 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $0.18
| Facility | | $0.18 | $0.18 | $0.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $0.18
| Professional | | $0.14 | $0.14 | $0.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.43 / $0.79
| Facility | | $0.19 | $0.43 | $0.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.19 / $0.28
| Professional | | $0.14 | $0.19 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.49
| Facility | | $0.19 | $0.19 | $0.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.38 / $0.41
| Professional | | $0.19 | $0.38 | $0.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.71
| Facility | | $0.20 | $0.20 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $223.87
| Professional | | $0.20 | $0.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $85.11
| Professional | | $50.12 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.28 / $0.28
| Facility | | $0.19 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.19 / $0.32
| Professional | | $0.14 | $0.19 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.54 / $1.02
| Professional | | $0.14 | $0.54 | $1.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $85.11 / $100.00
| Facility | | $0.15 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.56 / $223.87
| Professional | | $0.15 | $0.56 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $0.23
| Professional | | $0.19 | $0.19 | $0.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.47
| Facility | | $0.20 | $0.20 | $0.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.15 / $0.21
| Professional | | $0.15 | $0.15 | $0.21 |