- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $12.30 / $54.95
| Facility | | $5.75 | $12.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.57 / $11.75
| Professional | | $3.98 | $4.57 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $3.63
| Professional | | $3.63 | $3.63 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.03 / $10.47
| Facility | | $5.25 | $6.03 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.09 / $7.24
| Professional | | $2.45 | $3.09 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $4.57
| Professional | | $4.57 | $4.57 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $6.03 / $7.24
| Facility | | $3.63 | $6.03 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.75 / $7.76
| Professional | | $3.72 | $5.75 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.92 / $22.91
| Facility | | $3.80 | $6.92 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.47 / $9.55
| Professional | | $2.63 | $3.47 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $7.41 / $43.65
| Facility | | $3.72 | $7.41 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $4.07 / $8.51
| Professional | | $3.09 | $4.07 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $5.13 / $7.08
| Professional | | $4.27 | $5.13 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.03 / $11.75
| Professional | | $4.07 | $6.03 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $5.75 / $8.71
| Facility | | $2.40 | $5.75 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $3.47 / $6.92
| Professional | | $2.40 | $3.47 | $6.92 |