- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $7.24
| Facility | | $2.00 | $2.00 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $3.02
| Professional | | $1.00 | $2.00 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $7.41
| Facility | | $4.47 | $4.47 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $1.86 / $4.37
| Professional | | $0.91 | $1.86 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.61 / $7.08
| Facility | | $4.47 | $6.61 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.23
| Professional | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $21.88
| Facility | | $11.75 | $13.80 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $6.61 / $8.51
| Professional | | $2.24 | $6.61 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.63 / $6.31
| Facility | | $2.45 | $3.63 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $7.94 / $10.00
| Professional | | $3.98 | $7.94 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $4.27 / $9.77
| Facility | | $2.51 | $4.27 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.19 / $21.88
| Professional | | $1.86 | $2.19 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $33.11 / $70.79
| Professional | | $1.86 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $7.08
| Facility | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.01 / $8.71
| Professional | | $3.16 | $5.01 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.61 / $10.96
| Professional | | $4.07 | $6.61 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $79.43
| Facility | | $8.91 | $8.91 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $5.50 / $21.88
| Professional | | $2.24 | $5.50 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.19 / $3.55
| Professional | | $1.45 | $2.19 | $3.55 |