- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.51 / $17.38
| Facility | | $5.89 | $8.51 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $6.03
| Professional | | $5.01 | $5.01 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $12.88
| Facility | | $7.08 | $7.08 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $7.24
| Professional | | $5.75 | $5.75 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $8.71 / $15.85
| Facility | | $7.08 | $8.71 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $7.24 / $11.75
| Professional | | $5.75 | $7.24 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $6.31
| Facility | | $5.75 | $5.75 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $11.48 / $15.85
| Professional | | $6.31 | $11.48 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $6.31
| Facility | | $5.75 | $5.75 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.31 / $25.12
| Professional | | $5.75 | $6.31 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $85.11
| Professional | | $50.12 | $64.57 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Facility | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $6.03 / $10.23
| Professional | | $4.57 | $6.03 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.23 / $17.38
| Professional | | $5.75 | $10.23 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $85.11 / $95.50
| Facility | | $5.75 | $85.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.47 / $25.12
| Professional | | $5.75 | $10.47 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $7.76 / $9.55
| Professional | | $6.31 | $7.76 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $13.49
| Facility | | $5.75 | $5.75 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.03 / $6.46
| Professional | | $5.75 | $6.03 | $6.46 |