- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $53.70 / $93.33
| Facility | | $18.20 | $53.70 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $34.67
| Professional | | $14.13 | $15.85 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $5,011.87
| Facility | | $102.33 | $138.04 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $19.50
| Professional | | $15.14 | $15.14 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $30.20 / $67.61
| Facility | | $14.13 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.12 / $47.86
| Professional | | $11.48 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.50 / $28.18
| Professional | | $9.12 | $19.50 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $21.88 / $33.88
| Professional | | $19.50 | $21.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $51.29 / $67.61
| Facility | | $15.85 | $51.29 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $22.91
| Professional | | $14.13 | $15.85 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $28.18
| Facility | | $19.50 | $20.42 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $38.90
| Professional | | $19.50 | $20.42 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $19.50 / $23.44
| Facility | | $11.48 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $12.88 / $33.88
| Professional | | $8.71 | $12.88 | $33.88 |