- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.88 / $93.33
| Facility | | $16.22 | $33.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $21.88 / $53.70
| Professional | | $5.01 | $21.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $20.42
| Professional | | $10.47 | $10.47 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $58.88
| Facility | | $19.05 | $25.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $13.49
| Professional | | $8.91 | $12.59 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $15.85 / $19.95
| Professional | | $5.13 | $15.85 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $10.23 / $100.00
| Facility | | $4.90 | $10.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.90 / $8.91
| Professional | | $3.72 | $4.90 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Facility | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $4.90 / $10.96
| Facility | | $3.47 | $4.90 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $4.90 / $8.91
| Professional | | $4.68 | $4.90 | $8.91 |