- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $61.66 / $263.03
| Facility | | $25.70 | $61.66 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $52.48
| Professional | | $20.89 | $30.20 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $162.18
| Facility | | $107.15 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $61.66
| Professional | | $28.18 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $31.62 / $77.62
| Professional | | $8.13 | $31.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $524.81
| Facility | | $57.54 | $95.50 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $63.10
| Professional | | $24.55 | $34.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $47.86
| Professional | | $30.20 | $36.31 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $69.18
| Professional | | $33.88 | $42.66 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $61.66
| Facility | | $25.70 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $51.29
| Professional | | $30.20 | $30.20 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $26.30 / $61.66
| Facility | | $9.33 | $26.30 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $32.36 / $83.18
| Professional | | $9.77 | $32.36 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $35.48 / $251.19
| Facility | | $9.33 | $35.48 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $61.66
| Professional | | $21.38 | $33.88 | $61.66 |