- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $19.95 / $123.03
| Facility | | $10.96 | $19.95 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $16.98
| Professional | | $10.00 | $10.96 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $53.70
| Facility | | $32.36 | $45.71 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.23 / $13.18
| Professional | | $8.91 | $10.23 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $30.90 / $67.61
| Facility | | $10.23 | $30.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.23 / $22.39
| Professional | | $7.59 | $10.23 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $31.62 / $33.88
| Professional | | $9.55 | $31.62 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.88 / $28.18
| Facility | | $11.75 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $38.02 / $42.66
| Professional | | $11.75 | $38.02 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $14.79 / $25.70
| Facility | | $7.41 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $10.23 / $20.42
| Professional | | $6.17 | $10.23 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |