- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.00 / $2.63
| Facility | | $1.62 | $2.00 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $3.02
| Professional | | $1.00 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.57 / $5.01
| Professional | | $1.70 | $2.57 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.38 / $2.95
| Facility | | $1.38 | $1.38 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $2.95 / $3.72
| Professional | | $1.38 | $2.95 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $5.75 / $5.75
| Facility | | $2.19 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $6.92 / $15.85
| Facility | | $2.69 | $6.92 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.81 / $2.19 / $2.75
| Professional | | $0.81 | $2.19 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.34 / $5.62
| Professional | | $2.09 | $2.34 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.45 / $2.19
| Facility | | $1.15 | $1.45 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.78 / $2.19
| Professional | | $1.41 | $1.78 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.09 / $2.09 / $3.72
| Professional | | $2.09 | $2.09 | $3.72 |