- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $31.62 / $42.66
| Facility | | $10.00 | $31.62 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.00 / $15.85
| Professional | | $8.91 | $10.00 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $57.54
| Facility | | $30.20 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.71 / $19.50
| Professional | | $6.03 | $8.71 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $28.18 / $61.66
| Facility | | $9.33 | $28.18 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.33 / $20.42
| Professional | | $6.92 | $9.33 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $25.12 / $36.31
| Professional | | $11.22 | $25.12 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $26.30
| Facility | | $10.72 | $14.45 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $16.98
| Professional | | $10.72 | $15.14 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $14.79 / $23.44
| Facility | | $7.08 | $14.79 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.33 / $18.62
| Professional | | $6.76 | $9.33 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $100.00
| Facility | | $85.11 | $85.11 | $100.00 |