- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $54.95 / $158.49
| Facility | | $27.54 | $54.95 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $91.20
| Professional | | $8.91 | $15.85 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $114.82
| Facility | | $44.67 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $22.91
| Professional | | $14.79 | $21.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $33.88
| Professional | | $16.22 | $26.92 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $17.38 / $100.00
| Facility | | $5.01 | $17.38 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $8.32 / $15.14
| Professional | | $6.31 | $8.32 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $28.84
| Professional | | $16.98 | $16.98 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $218.78
| Facility | | $186.21 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $8.32 / $18.62
| Facility | | $5.89 | $8.32 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $8.32 / $15.14
| Professional | | $7.94 | $8.32 | $15.14 |