- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $3.31 / $4.37
| Facility | | $1.00 | $3.31 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.00
| Professional | | $1.00 | $1.00 | $1.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $3.16 / $5.37
| Facility | | $1.58 | $3.16 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $2.63
| Professional | | $1.58 | $1.58 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.45 / $3.72
| Professional | | $2.14 | $2.45 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.95 / $3.98
| Facility | | $2.19 | $2.95 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $1.58
| Professional | | $1.58 | $1.58 | $1.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.35 / $1.58 / $2.45
| Professional | | $1.35 | $1.58 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.58 / $2.45
| Facility | | $1.58 | $1.58 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.91 / $2.29
| Facility | | $1.48 | $1.91 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.48 / $1.91 / $2.29
| Professional | | $1.48 | $1.91 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.82 / $3.24
| Facility | | $1.51 | $1.82 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $1.58 / $2.00
| Professional | | $1.51 | $1.58 | $2.00 |