- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $2.04
| Facility | | $1.00 | $2.00 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.00
| Professional | | $1.00 | $1.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $1.95
| Professional | | $1.95 | $1.95 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.51 / $3.16
| Professional | | $1.23 | $1.51 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $2.04 / $2.88
| Facility | | $1.20 | $2.04 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.19 / $3.24
| Professional | | $1.58 | $2.19 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.55
| Facility | | $1.45 | $1.45 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.23 / $1.55
| Professional | | $1.23 | $1.23 | $1.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.55
| Facility | | $1.45 | $1.45 | $1.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.23 / $1.23 / $1.48
| Professional | | $1.23 | $1.23 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.48 / $2.14
| Professional | | $1.07 | $1.48 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.69 / $5.01
| Professional | | $2.34 | $2.69 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.78 / $0.98 / $1.58
| Facility | | $0.78 | $0.98 | $1.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $1.12 / $1.62
| Professional | | $0.79 | $1.12 | $1.62 |