- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $3.98
| Facility | | $1.70 | $1.70 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.70 / $2.88
| Professional | | $1.00 | $1.70 | $2.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $2.04 / $2.51
| Professional | | $1.78 | $2.04 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.78 / $3.16 / $5.62
| Professional | | $1.78 | $3.16 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.78 / $5.13
| Facility | | $1.58 | $1.78 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $1.78 / $407.38
| Professional | | $1.58 | $1.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.09 / $3.02
| Professional | | $1.82 | $2.09 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $1.82 / $3.98
| Professional | | $1.62 | $1.82 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $3.24 / $4.17
| Professional | | $1.91 | $3.24 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $2.69 / $3.39
| Facility | | $2.69 | $2.69 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.95 / $2.34
| Professional | | $1.74 | $1.95 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $2.14 / $2.29
| Facility | | $2.14 | $2.14 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.14 / $2.29
| Professional | | $1.70 | $2.14 | $2.29 |