- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $87.10 / $190.55
| Facility | | $28.84 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $42.66
| Professional | | $15.85 | $19.05 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $102.33
| Facility | | $19.50 | $30.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $51.29
| Professional | | $12.88 | $21.38 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $75.86
| Facility | | $41.69 | $52.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.92
| Professional | | $19.95 | $19.95 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $33.88 / $81.28
| Facility | | $16.60 | $33.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $54.95
| Professional | | $12.88 | $24.55 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $165.96 / $7,079.46
| Facility | | $24.55 | $165.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $36.31
| Professional | | $30.90 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $57.54
| Professional | | $21.38 | $21.38 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $177.83
| Facility | | $24.55 | $29.51 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $102.33
| Facility | | $19.50 | $30.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $51.29
| Professional | | $12.88 | $21.38 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $47.86
| Facility | | $18.62 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $31.62
| Professional | | $18.62 | $21.88 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $21.38 / $30.90
| Facility | | $10.72 | $21.38 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $57.54
| Professional | | $12.88 | $17.78 | $57.54 |