- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $5.25 / $22.39
| Facility | | $2.00 | $5.25 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.88
| Professional | | $2.00 | $2.00 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $2.82 / $4.68
| Facility | | $1.32 | $2.82 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $3.72
| Professional | | $2.24 | $2.24 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $4.68 / $5.89
| Facility | | $2.45 | $4.68 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $2.34
| Professional | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $3.80 / $7.08
| Professional | | $2.63 | $3.80 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.59
| Professional | | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.88 / $2.88 / $14.79
| Facility | | $2.88 | $2.88 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.45 / $3.39
| Facility | | $2.19 | $2.45 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.45 / $3.39
| Professional | | $2.19 | $2.45 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.32 / $12.59 / $16.60
| Facility | | $1.32 | $12.59 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.29 / $3.47
| Professional | | $2.24 | $2.29 | $3.47 |