- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.17 / $5.62
| Facility | | $2.00 | $4.17 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.40
| Professional | | $2.00 | $2.00 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.27 / $6.76
| Facility | | $2.00 | $4.27 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $5.89
| Professional | | $3.55 | $3.55 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.14
| Professional | | $2.00 | $2.00 | $2.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $6.61 / $9.33
| Facility | | $3.80 | $6.61 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $3.80
| Professional | | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $2.51 / $4.37
| Professional | | $1.91 | $2.51 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.14 / $4.47
| Facility | | $2.00 | $2.14 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $4.17
| Professional | | $2.00 | $2.00 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.17 / $5.37
| Facility | | $3.47 | $4.17 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.17 / $5.37
| Professional | | $3.47 | $4.17 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.19 / $4.79
| Facility | | $1.78 | $2.19 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.00 / $2.09
| Professional | | $1.78 | $2.00 | $2.09 |