- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Facility | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.66
| Professional | | $1.00 | $1.00 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.41 / $2.24
| Facility | | $1.41 | $1.41 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.63 / $3.31
| Professional | | $1.62 | $2.63 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.09 / $3.55
| Professional | | $2.00 | $3.09 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $2.34 / $79.43
| Facility | | $1.38 | $2.34 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.95 / $1.29 / $3.39
| Professional | | $0.95 | $1.29 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.57 / $2.69
| Professional | | $2.19 | $2.57 | $2.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $2.63
| Facility | | $2.24 | $2.24 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $3.31 / $3.31
| Professional | | $2.04 | $3.31 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.98 / $1.66
| Facility | | $0.68 | $0.98 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $1.00 / $2.14
| Professional | | $0.91 | $1.00 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.78 / $1.78
| Professional | | $1.41 | $1.78 | $1.78 |