- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.17
| Facility | | $1.00 | $1.00 | $1.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.66
| Professional | | $1.00 | $1.00 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.55 / $1.55
| Professional | | $1.55 | $1.55 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.23 / $1.51
| Facility | | $1.23 | $1.23 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.12 / $1.26
| Professional | | $1.12 | $1.12 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $79.43
| Facility | | $2.40 | $2.40 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.41 / $1.74
| Facility | | $1.41 | $1.41 | $1.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $1.41
| Professional | | $1.20 | $1.20 | $1.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $17.38
| Professional | | $12.02 | $17.38 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.95 / $3.16
| Facility | | $1.05 | $1.95 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.29
| Professional | | $1.00 | $1.00 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $1.55 / $1.78
| Professional | | $1.55 | $1.55 | $1.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.91 / $3.16
| Facility | | $1.15 | $1.91 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.20 / $1.45
| Professional | | $1.20 | $1.20 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.76 / $0.95 / $1.45
| Facility | | $0.76 | $0.95 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $1.10 / $1.45
| Professional | | $0.83 | $1.10 | $1.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $2.40 / $2.40
| Professional | | $1.17 | $2.40 | $2.40 |