- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $10.96
| Professional | | $1.00 | $2.00 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $2.29
| Professional | | $2.04 | $2.04 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.74 / $4.37
| Facility | | $1.38 | $1.74 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $4.68
| Professional | | $1.82 | $1.82 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.07 / $6.17
| Facility | | $3.02 | $4.07 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $5.37 / $10.72
| Professional | | $2.82 | $5.37 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $2.14
| Facility | | $1.74 | $1.74 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $2.04
| Professional | | $1.48 | $1.48 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $3.24 / $3.98
| Professional | | $2.34 | $3.24 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.63 / $5.13
| Professional | | $1.91 | $2.63 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $21.38
| Professional | | $14.79 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $4.27
| Professional | | $4.27 | $4.27 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $2.75 / $3.89
| Facility | | $0.85 | $2.75 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.48 / $2.82
| Professional | | $1.48 | $1.48 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $5.50
| Professional | | $5.50 | $5.50 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $3.09 / $5.89
| Professional | | $1.70 | $3.09 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $1.12 / $1.82
| Facility | | $0.20 | $1.12 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.29 / $3.16
| Professional | | $1.10 | $1.29 | $3.16 |