- 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 / $1.20
| Professional | | $1.00 | $1.00 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $6.76
| Professional | | $3.63 | $3.63 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $4.27
| Professional | | $4.27 | $4.27 | $4.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.62 / $1.62
| Facility | | $1.62 | $1.62 | $1.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.38 / $1.38 / $1.38
| Professional | | $1.38 | $1.38 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.34 / $4.07
| Professional | | $1.91 | $2.34 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $2.04 / $4.07
| Facility | | $1.35 | $2.04 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.70 / $2.09
| Professional | | $1.48 | $1.70 | $2.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.51 / $100.00
| Facility | | $1.91 | $2.51 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.51 / $100.00
| Professional | | $1.91 | $2.51 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $3.39 / $3.39
| Facility | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.20 / $1.58 / $3.02
| Professional | | $1.20 | $1.58 | $3.02 |