- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $5.01
| Facility | | $3.98 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $5.37
| Professional | | $3.02 | $3.98 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $7.41
| Facility | | $3.98 | $3.98 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $7.59 / $9.33
| Professional | | $4.07 | $7.59 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $6.61 / $7.24
| Professional | | $6.17 | $6.61 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $7.41 / $79.43
| Facility | | $4.47 | $7.41 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $10.96
| Professional | | $3.02 | $3.98 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $8.51
| Professional | | $7.24 | $7.41 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $7.41
| Facility | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $10.96 / $10.96
| Professional | | $5.62 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.31 / $4.68
| Facility | | $1.95 | $3.31 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.24 / $6.31
| Professional | | $2.75 | $3.24 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.17 / $6.17
| Professional | | $4.90 | $6.17 | $6.17 |