- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $35.48 / $128.82
| Facility | | $11.22 | $35.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $22.91 / $64.57
| Professional | | $6.03 | $22.91 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $67.61
| Facility | | $24.55 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $15.85
| Professional | | $10.47 | $15.14 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $18.62 / $23.44
| Professional | | $10.47 | $18.62 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $25.70 / $134.90
| Facility | | $5.89 | $25.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.89 / $17.78
| Professional | | $4.17 | $5.89 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $19.95
| Professional | | $10.47 | $10.47 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Facility | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.89 / $11.75
| Facility | | $4.07 | $5.89 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.89 / $10.72
| Professional | | $5.50 | $5.89 | $10.72 |