- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $10.00 / $12.02
| Professional | | $6.92 | $10.00 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.62 / $18.62
| Facility | | $14.45 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $11.22
| Professional | | $10.47 | $10.47 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $8.51
| Facility | | $8.32 | $8.32 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $9.33
| Professional | | $7.08 | $7.08 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.92 / $9.77
| Professional | | $6.46 | $6.92 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $12.02 / $20.42
| Facility | | $6.03 | $12.02 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.37 / $8.91
| Facility | | $4.37 | $5.37 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $6.76 / $9.77
| Professional | | $4.90 | $6.76 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Facility | | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $102.33
| Professional | | $70.79 | $70.79 | $102.33 |