- 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
- $5.01 / $7.08 / $10.96
| Professional | | $5.01 | $7.08 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $15.14
| Facility | | $14.13 | $14.13 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $16.98
| Professional | | $8.13 | $8.13 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $9.77
| Professional | | $7.76 | $7.76 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $9.55 / $9.55
| Facility | | $6.31 | $9.55 | $9.55 |
- 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
- $10.72 / $14.13 / $19.95
| Professional | | $10.72 | $14.13 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $9.33 / $13.80
| Professional | | $6.76 | $9.33 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $10.00 / $18.62
| Facility | | $5.75 | $10.00 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.94 / $9.33
| Professional | | $7.59 | $7.94 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $47.86
| Facility | | $7.94 | $11.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $47.86
| Professional | | $7.94 | $11.48 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $18.20
| Facility | | $6.03 | $10.00 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.92 / $10.96
| Professional | | $6.46 | $6.92 | $10.96 |