- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $61.66
| Facility | | $21.88 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $39.81
| Professional | | $16.98 | $21.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $50.12
| Facility | | $25.12 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $31.62
| Professional | | $10.96 | $14.13 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $31.62
| Facility | | $17.38 | $17.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $112.20
| Facility | | $17.78 | $33.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $40.74
| Professional | | $10.96 | $14.79 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $18.20 / $93.33
| Facility | | $17.78 | $18.20 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $23.99
| Professional | | $10.96 | $14.45 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $33.88
| Professional | | $20.42 | $24.55 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $56.23
| Professional | | $19.05 | $28.84 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $27.54 / $40.74
| Facility | | $11.48 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $27.54
| Professional | | $10.23 | $14.45 | $27.54 |