- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $97.72 / $218.78
| Facility | | $19.50 | $97.72 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $37.15
| Professional | | $14.13 | $16.98 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.18 / $79.43
| Professional | | $11.48 | $13.18 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $81.28
| Facility | | $42.66 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $17.38
| Professional | | $8.51 | $12.30 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $39.81 / $87.10
| Facility | | $13.18 | $39.81 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $13.18 / $28.84
| Professional | | $9.77 | $13.18 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $35.48 / $46.77
| Professional | | $15.85 | $35.48 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.60 / $37.15
| Facility | | $15.14 | $16.60 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $30.20
| Professional | | $15.14 | $26.92 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $169.82
| Facility | | $95.50 | $95.50 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $19.05 / $33.11
| Facility | | $9.55 | $19.05 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $13.18 / $26.30
| Professional | | $9.33 | $13.18 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |