- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $18.20 / $95.50
| Facility | | $3.80 | $18.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $6.46
| Professional | | $3.02 | $3.63 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $2.75 / $2.75
| Professional | | $2.45 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.89 / $7.94
| Facility | | $4.17 | $5.89 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $3.98
| Professional | | $3.02 | $3.63 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $8.91 / $14.45
| Facility | | $4.17 | $8.91 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.17 / $6.17
| Professional | | $2.45 | $4.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.47 / $64.57
| Professional | | $2.57 | $3.47 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $7.94
| Facility | | $3.98 | $3.98 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.98 / $7.94
| Professional | | $3.63 | $3.98 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.92 / $10.96
| Facility | | $3.98 | $6.92 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $4.79
| Professional | | $3.63 | $3.63 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.03 / $10.47
| Facility | | $4.57 | $6.03 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $3.98
| Professional | | $3.02 | $3.63 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.79 / $4.79
| Facility | | $3.63 | $4.79 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.34 / $5.62
| Professional | | $1.70 | $2.34 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.04 / $7.24
| Professional | | $1.82 | $2.04 | $7.24 |