- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $316.23
| Facility | | $33.11 | $87.10 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $33.11
| Professional | | $22.91 | $26.92 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $151.36
| Facility | | $35.48 | $35.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $26.92
| Professional | | $17.38 | $17.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $251.19
| Professional | | $104.71 | $165.96 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $158.49
| Facility | | $36.31 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $25.70 / $50.12
| Professional | | $19.50 | $25.70 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $52.48
| Professional | | $35.48 | $42.66 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $58.88 / $69.18
| Professional | | $29.51 | $58.88 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $32.36 / $33.11
| Facility | | $30.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $74.13 / $81.28
| Professional | | $30.20 | $74.13 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $50.12 / $10,000.00
| Facility | | $27.54 | $50.12 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $50.12 / $10,000.00
| Professional | | $27.54 | $50.12 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $35.48 / $60.26
| Facility | | $14.79 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $37.15
| Professional | | $14.79 | $21.38 | $37.15 |