- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $15.14
| Facility | | $12.88 | $12.88 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $41.69
| Professional | | $10.00 | $15.14 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.12 / $44.67 / $44.67
| Professional | 25 | $25.12 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $81.28 / $81.28
| Facility | | $9.55 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $39.81
| Professional | | $12.30 | $18.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $33.11
| Facility | | $14.45 | $14.45 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $33.88
| Professional | | $14.45 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $36.31
| Professional | | $13.49 | $19.95 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $12.30 / $17.78
| Facility | | $5.62 | $12.30 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $13.80 / $23.44
| Professional | | $8.71 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $22.91 / $38.90
| Professional | | $13.18 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $21.88 / $28.18
| Professional | | $13.80 | $21.88 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $81.28 / $81.28
| Facility | | $9.55 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $39.81
| Professional | | $12.30 | $18.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Facility | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $19.50 / $40.74
| Professional | | $12.30 | $19.50 | $40.74 |