- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $12.02
| Facility | | $5.01 | $5.01 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $5.01 / $21.88
| Professional | | $2.51 | $5.01 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Facility | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $9.12
| Professional | | $7.76 | $7.76 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.90 / $5.62
| Facility | | $3.98 | $4.90 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $4.90
| Professional | | $4.68 | $4.68 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $20.42
| Facility | | $8.71 | $12.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $13.18 / $19.95
| Professional | | $8.71 | $13.18 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.92 / $64.57
| Professional | | $6.17 | $6.92 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.94 / $8.71
| Facility | | $6.46 | $7.94 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $8.13 / $9.12
| Professional | | $7.41 | $8.13 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.94 / $14.45
| Facility | | $7.41 | $7.94 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $8.71
| Professional | | $7.41 | $7.41 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.76 / $9.55
| Professional | | $7.41 | $7.76 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.89 / $5.25
| Facility | | $3.31 | $3.89 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.27 / $7.59
| Professional | | $3.63 | $4.27 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $7.76 / $13.80
| Professional | | $3.63 | $7.76 | $13.80 |