- 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 / $8.51
| Professional | | $1.00 | $1.00 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.91 / $1.91
| Professional | | $1.74 | $1.91 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.45 / $2.19
| Facility | | $1.17 | $1.45 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $2.24 / $3.39
| Professional | | $1.17 | $2.24 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.75 / $79.43
| Facility | | $1.58 | $2.75 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $0.98 / $2.00
| Professional | | $0.66 | $0.98 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.19 / $5.25
| Professional | | $2.14 | $2.19 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.19
| Facility | | $2.19 | $2.19 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $4.90 / $5.25
| Professional | | $2.75 | $4.90 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.58 / $0.95 / $1.32
| Facility | | $0.58 | $0.95 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.66 / $0.98 / $1.55
| Professional | | $0.66 | $0.98 | $1.55 |