- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Facility | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.03
| Professional | | $3.02 | $3.98 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.92 / $7.08
| Professional | | $4.07 | $6.92 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.89 / $39.81
| Facility | | $9.12 | $20.89 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $7.24
| Professional | | $6.92 | $6.92 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $8.32 / $14.79
| Facility | | $4.27 | $8.32 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.55 / $9.77
| Professional | | $6.92 | $9.55 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.47
| Facility | | $4.17 | $4.17 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.80 / $5.01
| Professional | | $3.55 | $3.80 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.01 / $14.45
| Facility | | $4.57 | $5.01 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.50 / $8.32
| Professional | | $3.80 | $5.50 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.47
| Facility | | $4.17 | $4.17 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $5.13
| Professional | | $3.80 | $3.80 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.63 / $4.37
| Facility | | $1.91 | $2.63 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.24 / $4.90
| Professional | | $2.29 | $3.24 | $4.90 |