- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $3.98
| Professional | | $2.00 | $3.02 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $8.13
| Facility | | $6.76 | $6.76 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.47
| Professional | | $3.24 | $3.24 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $1.78 / $1.78
| Professional | | $1.78 | $1.78 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $4.27 / $12.30
| Facility | | $2.88 | $4.27 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $7.59
| Professional | | $7.41 | $7.41 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $4.17 / $4.37
| Professional | | $0.60 | $4.17 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.74 / $4.27
| Facility | | $1.58 | $1.74 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.04 / $2.88
| Professional | | $1.51 | $2.04 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $72.44 / $72.44
| Professional | | $38.02 | $72.44 | $72.44 |