- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $19.95 / $190.55
| Facility | | $11.22 | $19.95 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $12.88
| Professional | | $5.01 | $7.94 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $17.78
| Facility | | $9.12 | $12.88 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $7.94 / $8.71
| Professional | | $6.61 | $7.94 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.50 / $26.30
| Facility | | $9.12 | $19.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $9.33 / $13.49
| Professional | | $5.13 | $9.33 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.76 / $64.57
| Professional | | $5.62 | $7.76 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $17.38
| Facility | | $8.71 | $8.71 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $15.49 / $23.99
| Facility | | $8.71 | $15.49 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $10.47
| Professional | | $7.94 | $7.94 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $13.18 / $23.44
| Facility | | $10.00 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $7.94 / $8.71
| Professional | | $6.61 | $7.94 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $10.47
| Facility | | $7.94 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.90 / $10.47
| Professional | | $3.72 | $4.90 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $4.57 / $15.85
| Professional | | $3.98 | $4.57 | $15.85 |