- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $6.03 / $6.03
| Facility | | $5.01 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.03 / $7.94
| Professional | | $3.98 | $6.03 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $9.33
| Facility | | $5.75 | $5.75 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $11.22 / $14.13
| Professional | | $6.61 | $11.22 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $14.45
| Professional | | $7.76 | $9.77 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $9.55 / $79.43
| Facility | | $5.62 | $9.55 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.37 / $13.80
| Professional | | $3.98 | $5.37 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $10.96
| Professional | | $9.12 | $10.47 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $10.72
| Facility | | $9.33 | $9.33 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $13.80 / $13.80
| Professional | | $8.32 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $4.90 / $6.76
| Facility | | $2.82 | $4.90 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.47 / $8.91
| Professional | | $3.98 | $4.47 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $7.76
| Professional | | $6.17 | $7.76 | $7.76 |