- 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
- $5.01 / $10.00 / $12.02
| Professional | | $5.01 | $10.00 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $13.80
| Professional | | $11.75 | $11.75 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $53.70
| Facility | | $33.11 | $38.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $17.78 / $23.99
| Professional | | $6.03 | $17.78 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.96 / $12.30
| Facility | | $9.12 | $10.96 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $26.92
| Professional | | $11.22 | $15.14 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $19.05
| Facility | | $9.12 | $11.75 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $6.17 / $11.48
| Professional | | $4.79 | $6.17 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $12.30 / $19.05
| Professional | | $9.33 | $12.30 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $19.05 / $37.15
| Professional | | $12.59 | $19.05 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $79.43
| Facility | | $25.12 | $25.12 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $54.95 / $81.28
| Professional | | $5.89 | $54.95 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $16.22 / $95.50
| Professional | | $5.01 | $16.22 | $95.50 |