- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $72.44 / $72.44
| Facility | | $1.12 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Professional | | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.72 / $0.72
| Facility | | $0.65 | $0.72 | $0.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.83
| Professional | | $0.65 | $0.65 | $0.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.42 / $0.42 / $0.42
| Facility | | $0.42 | $0.42 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.36 / $0.42
| Professional | | $0.36 | $0.36 | $0.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.42 / $0.76 / $2.04
| Facility | | $0.42 | $0.76 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.41 / $0.76 / $1.45
| Professional | | $0.41 | $0.76 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $75.86
| Professional | | $60.26 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $0.76
| Facility | | $0.72 | $0.72 | $0.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.07 / $1.48
| Facility | | $0.65 | $1.07 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.62 / $0.72
| Professional | | $0.62 | $0.62 | $0.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $0.72
| Facility | | $0.72 | $0.72 | $0.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.83
| Professional | | $0.65 | $0.65 | $0.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.44 / $1.10 / $1.10
| Facility | | $0.44 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.31 / $0.46 / $0.65
| Professional | | $0.31 | $0.46 | $0.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.65 / $1.12
| Professional | | $0.52 | $0.65 | $1.12 |