- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $27.54 / $41.69
| Facility | | $12.88 | $27.54 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $23.44 / $64.57
| Professional | | $11.75 | $23.44 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $79.43
| Professional | 25 | $10.00 | $26.30 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $23.99
| Professional | | $11.48 | $16.98 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $42.66
| Professional | | $25.70 | $41.69 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $43.65
| Professional | | $16.22 | $28.18 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.50 / $43.65
| Facility | | $13.80 | $19.50 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $5,011.87 / $8,709.64
| Facility | | $4,466.84 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $15.85 / $31.62
| Professional | | $7.41 | $15.85 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Facility | | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.38 / $37.15
| Professional | | $14.13 | $21.38 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |