- 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
- $6.03 / $8.13 / $16.22
| Professional | | $6.03 | $8.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $17.78
| Professional | | $8.32 | $11.22 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Facility | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $8.32
| Professional | | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $15.85
| Professional | | $7.94 | $10.23 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $14.13
| Professional | | $11.22 | $13.80 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $10.47 / $16.98
| Facility | | $7.41 | $10.47 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $7.41 / $8.51
| Professional | | $6.46 | $7.41 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.47 / $15.85
| Facility | | $8.71 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.47 / $15.85
| Professional | | $8.71 | $10.47 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $8.71 / $12.02
| Facility | | $6.92 | $8.71 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $16.60
| Professional | | $7.24 | $10.23 | $16.60 |