- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $47.86 / $87.10
| Facility | | $12.02 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.72 / $20.89
| Professional | | $8.91 | $10.72 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $7.59 / $7.59
| Professional | | $7.41 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.78 / $23.99
| Facility | | $12.02 | $17.78 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.96 / $12.02
| Professional | | $9.12 | $10.96 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $24.55 / $30.90
| Facility | | $12.30 | $24.55 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $12.88 / $16.98
| Professional | | $6.46 | $12.88 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $13.80
| Facility | | $12.02 | $12.02 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $19.50 / $33.11
| Facility | | $12.02 | $19.50 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $14.45
| Professional | | $10.96 | $10.96 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.20 / $32.36
| Facility | | $13.80 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.96 / $12.02
| Professional | | $9.12 | $10.96 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $14.45
| Facility | | $11.48 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $5.13 / $12.59
| Professional | | $5.13 | $5.13 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $6.31 / $21.88
| Professional | | $5.50 | $6.31 | $21.88 |