- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $64.57
| Facility | | $22.91 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.88 / $30.90
| Professional | | $12.88 | $21.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.42 / $48.98
| Professional | | $16.60 | $20.42 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $44.67
| Facility | | $18.62 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $50.12
| Professional | | $23.99 | $33.11 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $23.44
| Facility | | $21.88 | $21.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $21.88
| Professional | | $18.62 | $18.62 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $60.26
| Facility | | $21.88 | $21.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $21.88
| Professional | | $18.62 | $18.62 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $23.99
| Professional | | $12.02 | $16.98 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $77.62
| Professional | | $35.48 | $41.69 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $23.99
| Facility | | $10.96 | $14.79 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $24.55
| Professional | | $11.75 | $17.38 | $24.55 |