- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $79.43 / $354.81
| Facility | | $19.50 | $79.43 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $19.50
| Professional | | $12.88 | $17.78 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.49 / $13.49
| Professional | | $12.02 | $13.49 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $38.90
| Facility | | $20.42 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $19.50
| Professional | | $14.79 | $17.78 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $43.65 / $70.79
| Facility | | $20.42 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $20.89 / $30.90
| Professional | | $12.30 | $20.89 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.38 / $64.57
| Professional | | $12.59 | $17.38 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $39.81
| Facility | | $19.50 | $19.50 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Professional | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $53.70
| Facility | | $19.50 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $23.44
| Professional | | $17.78 | $17.78 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $52.48
| Facility | | $22.39 | $29.51 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $19.50
| Professional | | $14.79 | $17.78 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $23.44
| Facility | | $17.78 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $11.48 / $23.44
| Professional | | $8.32 | $11.48 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $10.23 / $35.48
| Professional | | $8.91 | $10.23 | $35.48 |