- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $27.54 / $128.82
| Facility | | $14.13 | $27.54 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $13.18 / $70.79
| Professional | | $12.88 | $13.18 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $38.02 / $72.44
| Facility | | $9.12 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $9.12
| Professional | | $9.12 | $9.12 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $44.67
| Facility | | $12.02 | $12.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $11.22
| Professional | | $9.12 | $9.12 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $75.86
| Professional | | $64.57 | $64.57 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $58.88
| Facility | | $28.84 | $28.84 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $79.43
| Facility | | $46.77 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $46.77
| Professional | | $33.11 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $38.02 / $154.88
| Facility | | $9.12 | $38.02 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $9.12
| Professional | | $9.12 | $9.12 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $52.48
| Facility | | $22.39 | $22.39 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $22.39
| Professional | | $13.18 | $13.18 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $13.18
| Professional | | $9.12 | $11.75 | $13.18 |