- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $3.98 / $3.98
| Facility | | $1.62 | $3.98 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $5.01
| Professional | | $2.00 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $4.07
| Professional | | $3.80 | $3.80 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $18.62
| Facility | | $5.25 | $7.59 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.55
| Professional | | $3.16 | $3.16 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.37 / $7.41
| Professional | | $3.98 | $5.37 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $79.43
| Facility | | $6.76 | $6.76 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $4.47
| Facility | | $3.98 | $3.98 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $3.98
| Professional | | $3.39 | $3.39 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $50.12
| Professional | | $33.88 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $5.50 / $9.77
| Facility | | $3.24 | $5.50 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.98 / $6.46
| Professional | | $2.82 | $3.98 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $81.28
| Professional | | $3.72 | $3.72 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $5.37 / $9.55
| Facility | | $3.31 | $5.37 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $4.07
| Professional | | $3.39 | $3.39 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.69 / $4.07
| Facility | | $2.14 | $2.69 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.09 / $4.07
| Professional | | $2.34 | $3.09 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.76 / $6.76
| Professional | | $3.31 | $6.76 | $6.76 |