- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $25.12 / $109.65
| Facility | | $5.50 | $25.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $11.75 / $18.62
| Professional | | $9.77 | $11.75 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $8.71
| Professional | | $7.94 | $7.94 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.18 / $15.49
| Facility | | $11.48 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $18.62
| Professional | | $10.96 | $13.18 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $15.85 / $33.88
| Facility | | $9.12 | $15.85 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $13.49 / $25.70
| Professional | | $6.61 | $13.49 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $56.23 / $123.03
| Facility | | $13.18 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $18.20
| Professional | | $7.94 | $7.94 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $6.31 / $8.32
| Professional | | $1.58 | $6.31 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $10.72 / $16.22
| Facility | | $5.50 | $10.72 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.76 / $18.20
| Professional | | $5.25 | $7.76 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $13.18
| Professional | | $8.32 | $8.32 | $13.18 |