- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $6.31 / $9.55
| Facility | | $3.16 | $6.31 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $5.62
| Professional | | $3.02 | $3.02 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.47 / $5,011.87
| Facility | | $2.95 | $3.47 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $3.31
| Professional | | $3.31 | $3.31 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $11.22 / $12.02
| Facility | | $3.16 | $11.22 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.16
| Professional | | $3.16 | $3.16 | $3.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.16
| Facility | | $3.16 | $3.16 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $5.50 / $5.50
| Professional | | $4.79 | $5.50 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Facility | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.79 / $8.32
| Facility | | $3.02 | $4.79 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $3.39 / $9.77
| Facility | | $2.29 | $3.39 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $3.39 / $14.79
| Professional | | $2.24 | $3.39 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $2.95
| Facility | | $2.95 | $2.95 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $4.37
| Professional | | $3.16 | $3.16 | $4.37 |