- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $63.10 / $138.04
| Facility | | $10.72 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $30.90
| Professional | | $7.08 | $10.23 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $7.94 / $7.94
| Professional | | $3.16 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $51.29
| Facility | | $19.50 | $36.31 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $10.47
| Professional | | $5.25 | $7.59 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $23.99 / $52.48
| Facility | | $7.94 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $8.13 / $17.78
| Professional | | $6.03 | $8.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $21.38
| Professional | | $9.55 | $14.45 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $10.00 / $22.39
| Facility | | $9.33 | $10.00 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $26.92 / $30.20
| Professional | | $9.33 | $26.92 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,981.07
| Facility | | $3,388.44 | $3,388.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $11.48 / $19.95
| Facility | | $5.75 | $11.48 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.13 / $16.22
| Professional | | $4.79 | $8.13 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |