- 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
- $2.00 / $2.00 / $3.98
| Professional | | $2.00 | $2.00 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $7.94
| Facility | | $4.90 | $4.90 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.57 / $5.50
| Professional | | $4.37 | $4.57 | $5.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $14.79 / $23.44
| Facility | | $2.88 | $14.79 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $7.08 / $9.12
| Professional | | $2.45 | $7.08 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $4.17 / $6.92
| Facility | | $2.69 | $4.17 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $7.08 / $8.71
| Professional | | $4.37 | $7.08 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.79 / $79.43
| Facility | | $2.75 | $4.79 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.40 / $5.25
| Professional | | $2.04 | $2.40 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $33.11 / $70.79
| Professional | | $3.55 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Facility | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $5.50 / $9.55
| Professional | | $3.47 | $5.50 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $7.24 / $12.59
| Professional | | $4.90 | $7.24 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $9.77 / $79.43
| Facility | | $2.88 | $9.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.90 / $27.54
| Professional | | $2.45 | $4.90 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $4.90
| Professional | | $4.90 | $4.90 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $4.90
| Professional | | $4.90 | $4.90 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.55 / $2.19 / $3.47
| Facility | | $1.55 | $2.19 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.40 / $3.80
| Professional | | $1.58 | $2.40 | $3.80 |