- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $47.86 / $112.20
| Facility | | $12.30 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $11.22 / $17.38
| Professional | | $9.55 | $11.22 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $22.91
| Professional | | $5.25 | $7.59 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $24.55
| Facility | | $12.88 | $18.20 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.22 / $12.30
| Professional | | $9.33 | $11.22 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $27.54 / $39.81
| Facility | | $12.88 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.18 / $19.50
| Professional | | $7.59 | $13.18 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $13.18
| Professional | | $7.94 | $10.96 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $24.55
| Facility | | $12.30 | $12.30 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $24.55
| Professional | | $12.30 | $12.30 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $21.88 / $33.88
| Facility | | $12.30 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $14.79
| Professional | | $11.22 | $11.22 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $33.11
| Facility | | $14.13 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $11.22 / $12.30
| Professional | | $9.33 | $11.22 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $14.79
| Facility | | $11.22 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.24 / $15.85
| Professional | | $5.25 | $7.24 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $6.46 / $22.39
| Professional | | $5.62 | $6.46 | $22.39 |