- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $9.33 / $32.36
| Facility | | $2.95 | $9.33 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $3.55
| Professional | | $2.00 | $2.69 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $4.47 / $6.03
| Facility | | $3.16 | $4.47 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.69 / $3.02
| Professional | | $2.29 | $2.69 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.76 / $9.77
| Facility | | $3.16 | $6.76 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.09 / $4.57
| Professional | | $1.82 | $3.09 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.63 / $64.57
| Professional | | $1.95 | $2.63 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.89
| Facility | | $3.02 | $3.02 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $3.63
| Professional | | $3.02 | $3.63 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $5.25 / $8.32
| Facility | | $3.02 | $5.25 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $3.63
| Professional | | $2.69 | $2.69 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.57 / $7.94
| Facility | | $3.47 | $4.57 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.69 / $3.02
| Professional | | $2.29 | $2.69 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.63 / $3.63
| Facility | | $2.69 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $1.74 / $3.80
| Professional | | $1.26 | $1.74 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.55 / $5.50
| Professional | | $1.35 | $1.55 | $5.50 |