- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $50.12 / $165.96
| Facility | | $16.98 | $50.12 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $35.48
| Professional | | $15.85 | $19.05 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $14.79
| Professional | | $14.13 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $91.20
| Facility | | $46.77 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $19.05 / $19.05
| Professional | | $9.55 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $44.67 / $95.50
| Facility | | $14.79 | $44.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $32.36
| Professional | | $10.96 | $14.79 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $38.90 / $58.88
| Professional | | $17.78 | $38.90 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.62 / $41.69
| Facility | | $16.98 | $18.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $41.69 / $45.71
| Professional | | $16.98 | $41.69 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $1,548.82
| Facility | | $812.83 | $812.83 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $21.38 / $37.15
| Facility | | $11.22 | $21.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $29.51
| Professional | | $10.72 | $14.79 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |