- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $93.33
| Facility | | $30.90 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $47.86
| Professional | | $25.70 | $30.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $40.74 / $70.79
| Facility | | $35.48 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.95 / $44.67
| Professional | | $15.49 | $19.95 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $44.67
| Facility | | $23.44 | $23.44 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $194.98
| Facility | | $25.70 | $46.77 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $18.20 / $74.13
| Professional | | $17.38 | $18.20 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $81.28
| Facility | | $25.12 | $25.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $18.20 / $33.11
| Professional | | $17.38 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $47.86
| Professional | | $28.84 | $36.31 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $79.43
| Professional | | $26.92 | $40.74 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $38.90 / $57.54
| Facility | | $13.80 | $38.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $38.90
| Professional | | $16.22 | $22.91 | $38.90 |