- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $42.66 / $169.82
| Facility | | $20.89 | $42.66 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $57.54
| Professional | | $15.49 | $18.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $12.88 / $32.36
| Professional | | $10.47 | $12.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $21.88 / $38.02
| Facility | | $19.05 | $21.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $26.92
| Professional | | $10.23 | $12.88 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Facility | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $26.30
| Facility | | $14.13 | $21.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $20.89 / $28.18
| Professional | | $13.49 | $20.89 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $26.92 / $85.11
| Facility | | $14.13 | $26.92 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.49 / $39.81
| Professional | | $10.47 | $13.49 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $57.54 / $144.54
| Facility | | $13.49 | $57.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $15.49 / $38.90
| Professional | | $8.32 | $15.49 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $25.70
| Professional | | $15.49 | $18.62 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $42.66
| Professional | | $14.45 | $22.91 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $20.89 / $31.62
| Facility | | $11.48 | $20.89 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $28.84
| Professional | | $8.71 | $12.59 | $28.84 |