- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $18.20
| Professional | | $8.91 | $15.14 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $100.00
| Professional | | $15.85 | $25.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.02 / $38.02
| Professional | | $11.75 | $12.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $14.79 / $26.92
| Facility | | $9.33 | $14.79 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $15.14 / $32.36
| Facility | | $9.77 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $100.00
| Professional | | $16.60 | $28.84 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $54.95 / $70.79
| Professional | | $50.12 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $51.29
| Professional | | $20.89 | $36.31 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $100.00 / $100.00
| Facility | | $35.48 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $100.00 / $100.00
| Professional | | $12.02 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $57.54
| Professional | | $16.60 | $23.99 | $57.54 |