- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $109.65
| Facility | | $47.86 | $89.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $47.86
| Professional | | $25.70 | $32.36 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $109.65
| Facility | | $87.10 | $107.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $123.03
| Professional | | $16.22 | $16.22 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $208.93
| Facility | | $109.65 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $57.54 / $125.89
| Professional | | $46.77 | $57.54 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $51.29 / $83.18
| Facility | | $9.33 | $51.29 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $36.31 / $190.55
| Facility | | $9.33 | $36.31 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $23.99 / $61.66
| Professional | | $8.51 | $23.99 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $33.11 / $64.57
| Professional | | $14.13 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $61.66
| Facility | | $29.51 | $47.86 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $114.82
| Professional | | $19.95 | $40.74 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $93.33 / $131.83
| Professional | | $43.65 | $93.33 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $190.55
| Facility | | $79.43 | $79.43 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $10.23
| Professional | | $6.92 | $6.92 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $85.11
| Professional | | $10.72 | $10.72 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $45.71 / $223.87
| Professional | | $10.72 | $45.71 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $32.36 / $47.86
| Facility | | $14.45 | $32.36 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $23.99 / $60.26
| Professional | | $8.71 | $23.99 | $60.26 |