- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.00
| Facility | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $3.02
| Professional | | $1.00 | $2.00 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $6.03
| Facility | | $3.72 | $3.72 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.47 / $4.17
| Professional | | $3.31 | $3.47 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $5.75
| Facility | | $4.37 | $4.37 | $5.75 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $11.48 / $18.62
| Facility | | $2.19 | $11.48 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $5.13 / $7.08
| Professional | | $1.86 | $5.13 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.16 / $5.25
| Facility | | $2.04 | $3.16 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $4.90 / $6.03
| Professional | | $3.31 | $4.90 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $3.63 / $79.43
| Facility | | $2.09 | $3.63 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.82 / $3.98
| Professional | | $1.55 | $1.82 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $33.11 / $70.79
| Professional | | $1.74 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $5.75
| Facility | | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $4.17 / $7.24
| Professional | | $2.63 | $4.17 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.50 / $9.55
| Professional | | $3.72 | $5.50 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $7.41 / $79.43
| Facility | | $2.19 | $7.41 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $3.72 / $18.20
| Professional | | $1.86 | $3.72 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $3.72
| Professional | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $3.72 / $3.72
| Professional | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.62 / $2.63
| Facility | | $1.17 | $1.62 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.82 / $2.88
| Professional | | $1.20 | $1.82 | $2.88 |