- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $3.02
| Facility | | $2.00 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $2.00 / $3.02
| Professional | | $1.00 | $2.00 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $4.47
| Facility | | $2.40 | $2.40 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.47 / $5.62
| Professional | | $2.45 | $4.47 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $5.50 / $6.17
| Professional | | $3.80 | $5.50 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.37 / $79.43
| Facility | | $2.75 | $4.37 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.45 / $6.76
| Professional | | $1.82 | $2.45 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.57 / $5.25
| Professional | | $4.37 | $4.57 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $4.47
| Facility | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $6.76 / $6.76
| Professional | | $3.47 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $2.04 / $2.82
| Facility | | $1.17 | $2.04 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.00 / $3.80
| Professional | | $1.70 | $2.00 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.80 / $3.80
| Professional | | $3.02 | $3.80 | $3.80 |