- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $8.71 / $52.48
| Facility | | $2.14 | $8.71 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $4.27
| Professional | | $2.00 | $2.00 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.68 / $14.13
| Facility | | $2.34 | $4.68 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.51 / $4.07
| Professional | | $2.14 | $2.51 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $2.88
| Facility | | $2.88 | $2.88 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.51 / $2.51
| Facility | | $2.51 | $2.51 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.47 / $3.47
| Professional | | $3.47 | $3.47 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $4.57 / $7.08
| Facility | | $4.07 | $4.57 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.14
| Professional | | $2.14 | $2.14 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $4.90 / $22.91
| Facility | | $2.04 | $4.90 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $13.49
| Professional | | $2.14 | $2.14 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.82 / $3.55
| Professional | | $2.14 | $2.82 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.63 / $5.01
| Professional | | $2.04 | $3.63 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $2.19 / $2.19
| Facility | | $1.26 | $2.19 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $2.14 / $2.82
| Professional | | $1.02 | $2.14 | $2.82 |