- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.31 / $5.01
| Professional | | $3.02 | $3.31 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $11.22
| Facility | | $6.76 | $6.76 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.31 / $7.59
| Professional | | $6.17 | $6.31 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $20.89 / $33.88
| Facility | | $3.98 | $20.89 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $9.77 / $12.88
| Professional | | $3.39 | $9.77 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.75 / $9.55
| Facility | | $3.72 | $5.75 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $10.47 / $12.88
| Professional | | $6.03 | $10.47 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.61 / $79.43
| Facility | | $3.80 | $6.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $3.31 / $7.24
| Professional | | $2.82 | $3.31 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $33.11 / $70.79
| Professional | | $2.95 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $10.72
| Facility | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $7.59 / $13.18
| Professional | | $4.79 | $7.59 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $10.23 / $17.78
| Professional | | $6.76 | $10.23 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $13.49 / $79.43
| Facility | | $3.98 | $13.49 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $6.76 / $33.11
| Professional | | $3.39 | $6.76 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.02 / $4.90
| Facility | | $2.19 | $3.02 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.31 / $5.37
| Professional | | $2.19 | $3.31 | $5.37 |