- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $5.50 / $17.38
| Facility | | $3.89 | $5.50 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $6.03
| Professional | | $2.00 | $2.00 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $3.24 / $7.94
| Facility | | $2.75 | $3.24 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $6.17
| Professional | | $2.63 | $2.63 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $3.39 / $4.47
| Facility | | $2.88 | $3.39 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.39 / $7.41
| Professional | | $2.63 | $3.39 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.57 / $6.17
| Facility | | $2.75 | $4.57 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $2.75
| Professional | | $2.63 | $2.63 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.88 / $6.31
| Professional | | $2.34 | $2.88 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $2.51 / $2.51
| Professional | | $2.51 | $2.51 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.98 / $6.61
| Facility | | $2.63 | $3.98 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $3.80
| Professional | | $2.63 | $2.63 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $3.98
| Professional | | $3.98 | $3.98 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.40 / $2.88
| Professional | | $2.09 | $2.40 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $7.41 / $7.41
| Facility | | $2.63 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $6.46
| Professional | | $2.63 | $2.63 | $6.46 |