- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $83.18 / $154.88
| Facility | | $13.80 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $11.48 / $33.11
| Professional | | $3.39 | $11.48 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $8.91 / $12.88
| Professional | | $3.63 | $8.91 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $38.02 / $61.66
| Facility | | $20.42 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.94 / $8.51
| Professional | | $5.62 | $7.94 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $9.55 / $12.02
| Professional | | $5.75 | $9.55 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $95.50 / $141.25
| Facility | | $8.13 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $3.16 / $9.55
| Professional | | $2.57 | $3.16 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $10.72
| Professional | | $6.31 | $6.31 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $6.31
| Facility | | $6.31 | $6.31 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $3.09 / $6.92
| Facility | | $2.19 | $3.09 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.09 / $5.75
| Professional | | $2.95 | $3.09 | $5.75 |