- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.03 / $8.91
| Professional | | $3.98 | $6.03 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $7.08
| Facility | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $5.25
| Professional | | $5.25 | $5.25 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $24.55 / $30.90
| Professional | | $11.22 | $24.55 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $15.14
| Facility | | $7.94 | $11.22 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $11.75 / $16.60
| Professional | | $10.96 | $11.75 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $14.79
| Facility | | $11.75 | $14.45 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $16.22
| Professional | | $14.79 | $14.79 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $11.48 / $16.60
| Facility | | $7.24 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $14.13 / $70.79
| Professional | | $5.25 | $14.13 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $23.44 / $57.54
| Facility | | $12.30 | $23.44 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $16.60
| Professional | | $14.79 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $8.32 / $18.20
| Facility | | $6.31 | $8.32 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $5.50 / $10.47
| Professional | | $4.37 | $5.50 | $10.47 |