- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $12.88
| Facility | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.96 / $15.85
| Professional | | $8.91 | $10.96 | $15.85 |
- 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
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $41.69 / $50.12
| Professional | | $16.98 | $41.69 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $16.98 / $22.91
| Facility | | $13.49 | $16.98 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $25.12
| Professional | | $16.22 | $18.20 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $22.39
| Facility | | $17.78 | $21.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $24.55
| Professional | | $17.78 | $22.39 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $18.62 / $25.70
| Facility | | $11.22 | $18.62 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $21.38 / $70.79
| Professional | | $10.47 | $21.38 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $87.10
| Facility | | $18.62 | $35.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $25.12
| Professional | | $22.39 | $25.12 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.13 / $30.90
| Facility | | $12.59 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $9.33 / $17.78
| Professional | | $8.51 | $9.33 | $17.78 |