- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $5.13
| Facility | | $2.00 | $2.00 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $5.01
| Professional | | $1.00 | $2.00 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $3.31
| Facility | | $3.31 | $3.31 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $3.31 / $4.27
| Professional | | $3.31 | $3.31 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $2.40 / $2.45
| Facility | | $2.29 | $2.40 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $1.95 / $2.40
| Professional | | $1.95 | $1.95 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.29 / $4.37 / $7.94
| Facility | | $2.29 | $4.37 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $4.68 / $7.94
| Professional | | $2.40 | $4.68 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.95 / $64.57
| Professional | | $2.63 | $2.95 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.72 / $3.80
| Facility | | $3.47 | $3.72 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $7.59
| Professional | | $3.80 | $3.80 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.31 / $6.17
| Facility | | $3.16 | $3.31 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $3.72
| Professional | | $3.16 | $3.16 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $3.31 / $4.27
| Professional | | $3.09 | $3.31 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.74 / $2.51
| Facility | | $1.48 | $1.74 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.62 / $3.09
| Professional | | $1.51 | $1.62 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $3.31 / $5.89
| Professional | | $1.62 | $3.31 | $5.89 |