- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $66.07 / $208.93
| Facility | | $16.22 | $66.07 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $25.12
| Professional | | $15.14 | $18.20 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $14.13 / $14.13
| Professional | | $13.49 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $75.86
| Facility | | $45.71 | $63.10 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $18.62
| Professional | | $12.30 | $14.13 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $42.66 / $93.33
| Facility | | $14.13 | $42.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $30.90
| Professional | | $10.47 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $48.98 / $50.12
| Professional | | $15.85 | $48.98 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $17.78 / $39.81
| Facility | | $16.22 | $17.78 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $21.38 / $23.99
| Professional | | $16.22 | $21.38 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $20.42 / $35.48
| Facility | | $10.72 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.13 / $28.18
| Professional | | $10.23 | $14.13 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $128.82
| Facility | | $97.72 | $97.72 | $128.82 |