- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.37 / $10.72
| Facility | | $3.72 | $5.37 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $6.17
| Professional | | $3.02 | $3.02 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $7.94
| Facility | | $4.47 | $4.47 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $4.57
| Professional | | $3.55 | $3.55 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.91 / $12.88
| Facility | | $4.79 | $8.91 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.57 / $6.61
| Professional | | $3.55 | $4.57 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.63 / $7.76
| Facility | | $2.63 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $7.24 / $7.24
| Professional | | $5.37 | $7.24 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.63 / $7.76
| Facility | | $2.63 | $3.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $5.75
| Professional | | $3.63 | $3.63 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $85.11
| Professional | | $64.57 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.72 / $3.72
| Facility | | $3.55 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.07 / $12.02
| Professional | | $3.55 | $4.07 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $85.11
| Facility | | $3.63 | $3.63 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $3.63
| Professional | | $3.63 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.79 / $5.89
| Professional | | $3.72 | $4.79 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $8.32
| Facility | | $3.55 | $3.55 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $4.90
| Professional | | $3.63 | $3.63 | $4.90 |