- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $7.59 / $7.59
| Facility | | $2.00 | $7.59 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $7.59
| Professional | | $2.00 | $2.00 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Facility | | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.82 / $2.88
| Professional | | $2.24 | $2.82 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $16.22 / $17.78
| Professional | | $2.75 | $16.22 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $7.59 / $100.00
| Facility | | $1.95 | $7.59 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.79 / $1.95 / $8.13
| Professional | | $0.79 | $1.95 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.45 / $7.76
| Professional | | $2.04 | $2.45 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $2.63
| Facility | | $2.63 | $2.63 | $2.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.02 / $0.68 / $1.70
| Facility | | $0.02 | $0.68 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.87 / $2.19 / $3.63
| Professional | | $0.87 | $2.19 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $2.75
| Facility | | $2.19 | $2.19 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.40 / $3.02
| Professional | | $1.91 | $2.40 | $3.02 |