- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $87.10 / $87.10
| Facility | | $26.92 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $40.74 / $87.10
| Professional | | $13.49 | $40.74 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $257.04
| Facility | | $165.96 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $22.39
| Professional | | $7.24 | $7.24 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $69.18 / $104.71
| Professional | | $43.65 | $69.18 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $42.66 / $162.18
| Facility | | $1.74 | $42.66 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $21.88 / $33.88
| Professional | | $9.77 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $50.12
| Professional | | $33.11 | $47.86 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $24.55 / $28.84
| Professional | | $12.30 | $24.55 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $13.18 / $13.18
| Facility | | $12.59 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $12.59
| Professional | | $8.13 | $8.13 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $44.67 / $10,000.00
| Facility | | $16.98 | $44.67 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $46.77 / $10,000.00
| Professional | | $16.60 | $46.77 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $43.65
| Facility | | $12.59 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.50 / $25.70
| Professional | | $8.71 | $19.50 | $25.70 |