- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.50 / $25.70
| Facility | | $10.00 | $19.50 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Facility | 25 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $9.12 / $35.48
| Professional | | $7.41 | $9.12 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $9.12 / $15.14
| Professional | | $7.59 | $9.12 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $9.33 / $9.33
| Facility | | $8.71 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $9.33 / $10.00
| Professional | | $8.71 | $9.33 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $9.77 / $24.55
| Facility | | $6.03 | $9.77 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.51 / $18.20
| Professional | | $8.32 | $8.51 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.96 / $33.11
| Professional | | $7.59 | $10.96 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.89 / $25.70
| Facility | | $9.12 | $20.89 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Facility | 25 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.72 / $28.84
| Professional | | $7.59 | $10.72 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.47 / $13.49
| Professional | | $7.59 | $10.47 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $8.71
| Facility | | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $16.60
| Professional | | $8.13 | $10.00 | $16.60 |