- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $3.02 / $16.98
| Professional | | $1.00 | $3.02 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $3.80 / $3.80
| Professional | | $3.47 | $3.80 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.51 / $4.37
| Facility | | $2.34 | $2.51 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $4.47 / $6.61
| Professional | | $2.34 | $4.47 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $5.50 / $79.43
| Facility | | $3.16 | $5.50 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $1.95 / $3.98
| Professional | | $1.29 | $1.95 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $10.47
| Professional | | $4.27 | $4.27 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $4.37
| Facility | | $4.37 | $4.37 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $9.77 / $10.47
| Professional | | $5.37 | $9.77 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $1.78 / $2.51
| Facility | | $1.12 | $1.78 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.95 / $3.02
| Professional | | $1.35 | $1.95 | $3.02 |