- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.14 / $7.76
| Facility | | $2.00 | $2.14 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.00 / $3.02
| Professional | | $1.32 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.09 / $5.01
| Professional | | $2.19 | $3.09 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.13 / $12.02
| Facility | | $3.47 | $5.13 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.72
| Professional | | $3.24 | $3.24 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Facility | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $6.92
| Facility | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $1.82
| Professional | | $1.82 | $1.82 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $45.71
| Professional | | $32.36 | $32.36 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.47 / $8.51
| Facility | | $2.45 | $4.47 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $2.00 / $3.80
| Professional | | $1.26 | $2.00 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.72
| Professional | | $3.24 | $3.24 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.17 / $8.51
| Professional | | $4.47 | $6.17 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.47 / $8.32
| Facility | | $2.45 | $4.47 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $4.07
| Professional | | $1.82 | $1.82 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.78 / $2.88
| Facility | | $1.38 | $1.78 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.00 / $3.02
| Professional | | $1.51 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $4.47 / $5.50
| Professional | | $2.04 | $4.47 | $5.50 |