- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Facility | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $10.00 / $54.95
| Professional | | $3.39 | $10.00 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.02 / $12.30
| Professional | | $10.96 | $12.02 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $7.59 / $14.13
| Facility | | $4.90 | $7.59 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $14.13 / $21.38
| Professional | | $6.31 | $14.13 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $16.98 / $79.43
| Facility | | $9.33 | $16.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.17 / $12.02
| Professional | | $4.17 | $6.17 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $33.88
| Professional | | $11.75 | $13.80 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $14.13
| Facility | | $12.02 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.90 / $33.88
| Professional | | $17.38 | $30.90 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $5.75 / $8.13
| Facility | | $3.72 | $5.75 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $6.03 / $9.77
| Professional | | $4.17 | $6.03 | $9.77 |