- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $19.05 / $67.61
| Facility | | $4.90 | $19.05 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.07 / $27.54
| Professional | | $3.02 | $4.07 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.09 / $8.32
| Professional | | $3.09 | $3.09 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.61 / $8.91
| Facility | | $4.68 | $6.61 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.07 / $4.47
| Professional | | $3.39 | $4.07 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $10.00 / $16.22
| Facility | | $4.68 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.79 / $7.08
| Professional | | $2.75 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.89 / $4.79
| Professional | | $2.88 | $3.89 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $8.71
| Facility | | $4.47 | $4.47 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $7.76 / $12.30
| Facility | | $4.47 | $7.76 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $5.37
| Professional | | $4.07 | $4.07 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $6.76 / $11.75
| Facility | | $5.13 | $6.76 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.07 / $4.47
| Professional | | $3.39 | $4.07 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.37 / $5.37
| Facility | | $4.07 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.63 / $5.75
| Professional | | $1.86 | $2.63 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.29 / $8.13
| Professional | | $2.04 | $2.29 | $8.13 |