- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $17.78 / $194.98
| Facility | | $11.75 | $17.78 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $14.45
| Professional | | $6.03 | $8.91 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $25.12 / $33.88
| Facility | | $15.49 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $10.72 / $17.78
| Professional | | $6.46 | $10.72 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.42 / $23.99
| Professional | | $19.05 | $20.42 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $17.78
| Facility | | $9.33 | $9.33 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $12.88 / $19.05
| Professional | | $9.33 | $12.88 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $18.62
| Facility | | $9.33 | $9.33 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $11.22
| Professional | | $9.33 | $9.33 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $28.18
| Facility | | $9.12 | $13.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.22 / $79.43
| Professional | | $9.33 | $11.22 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $28.18 / $38.90
| Facility | | $14.13 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $12.02
| Professional | | $7.08 | $9.55 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $11.22 / $15.14
| Facility | | $5.89 | $11.22 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.37 / $13.18
| Professional | | $3.98 | $5.37 | $13.18 |