- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $104.71
| Facility | | $28.84 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $35.48
| Professional | | $15.85 | $21.88 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $79.43
| Facility | | $37.15 | $60.26 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $61.66
| Professional | | $23.99 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $102.33
| Professional | | $81.28 | $89.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $50.12
| Facility | | $22.91 | $22.91 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $39.81
| Professional | | $22.91 | $30.20 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $45.71
| Facility | | $22.91 | $25.70 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $43.65
| Professional | | $22.91 | $26.30 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $67.61
| Facility | | $22.39 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $61.66
| Professional | | $22.91 | $32.36 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $69.18 / $95.50
| Facility | | $34.67 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $28.18
| Professional | | $17.38 | $22.91 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $27.54 / $37.15
| Facility | | $14.13 | $27.54 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $10.47 / $32.36
| Professional | | $9.77 | $10.47 | $32.36 |