- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.35 / $2.00
| Facility | | $1.00 | $1.35 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $2.00 / $5.01
| Professional | | $1.12 | $2.00 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.85 / $0.85 / $1.51
| Facility | | $0.85 | $0.85 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.85
| Professional | | $0.68 | $0.68 | $0.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.74 / $1.35 / $2.04
| Facility | | $0.74 | $1.35 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.83 / $1.26
| Professional | | $0.68 | $0.83 | $1.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.71 / $1.41
| Facility | | $0.71 | $0.71 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.05 / $1.41 / $1.41
| Professional | | $1.05 | $1.41 | $1.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $1.41
| Facility | | $0.65 | $0.65 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $1.41
| Professional | | $0.65 | $0.65 | $1.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $54.95 / $85.11
| Professional | | $0.68 | $54.95 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.95
| Facility | | $0.52 | $0.52 | $0.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $1.05 / $2.34
| Professional | | $0.68 | $1.05 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $85.11
| Facility | | $0.68 | $0.68 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.68
| Professional | | $0.68 | $0.68 | $0.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $0.91 / $1.12
| Professional | | $0.91 | $0.91 | $1.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $0.59 / $1.38
| Facility | | $0.59 | $0.59 | $1.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.68 / $0.68 / $0.93
| Professional | | $0.68 | $0.68 | $0.93 |