- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $93.33 / $169.82
| Facility | | $33.88 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $177.83
| Professional | | $18.20 | $22.91 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $63.10 / $134.90
| Facility | | $15.85 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $41.69
| Professional | | $10.96 | $15.14 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $114.82 / $309.03
| Facility | | $47.86 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $69.18
| Professional | | $15.85 | $21.88 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $47.86 / $95.50
| Facility | | $18.62 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.11 / $47.86
| Professional | | $14.45 | $33.11 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $43.65
| Professional | | $21.88 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $61.66
| Professional | | $21.88 | $26.92 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $69.18
| Facility | | $19.95 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $53.70
| Professional | | $14.45 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $37.15
| Professional | | $21.88 | $24.55 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $26.92
| Facility | | $11.48 | $16.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $51.29
| Professional | | $11.48 | $12.59 | $51.29 |