- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.78 / $3.55
| Facility | | $1.00 | $1.78 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.48
| Professional | | $1.00 | $1.00 | $1.48 |
- 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
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $1.51 / $4.37
| Facility | | $0.68 | $1.51 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.65
| Professional | | $0.65 | $0.65 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.55 / $1.32 / $2.45
| Facility | | $0.55 | $1.32 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.70
| Professional | | $1.00 | $1.00 | $1.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $1.07 / $2.04
| Facility | | $0.65 | $1.07 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $0.65
| Professional | | $0.65 | $0.65 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $0.32
| Facility | | $0.14 | $0.14 | $0.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.36 / $0.36
| Professional | | $0.36 | $0.36 | $0.36 |