- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Facility | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.29
| Professional | | $1.00 | $1.00 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.10 / $1.10
| Facility | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $0.93 / $0.93
| Professional | | $0.93 | $0.93 | $0.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $3.72 / $4.27
| Professional | | $1.20 | $3.72 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.23 / $1.86
| Facility | | $1.05 | $1.23 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.45 / $1.91
| Professional | | $1.15 | $1.45 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.51 / $1.78
| Facility | | $1.41 | $1.51 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.55 / $1.82
| Professional | | $1.35 | $1.55 | $1.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.38 / $1.95
| Facility | | $0.93 | $1.38 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.93 / $1.48 / $79.43
| Professional | | $0.93 | $1.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.74 / $1.74
| Professional | | $1.38 | $1.74 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.71 / $0.85
| Facility | | $0.62 | $0.71 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $0.78 / $1.48
| Professional | | $0.62 | $0.78 | $1.48 |