- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.75 / $263.03
| Facility | | $5.01 | $11.75 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $7.08
| Professional | | $5.01 | $5.01 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Professional | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $23.99 / $47.86
| Facility | | $9.77 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Professional | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.50 / $79.43
| Facility | | $5.50 | $5.50 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $12.30 / $33.88
| Facility | | $5.62 | $12.30 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $5.01
| Professional | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $416.87
| Professional | | $234.42 | $234.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.76 / $39.81
| Facility | | $5.50 | $7.76 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $7.41
| Professional | | $5.01 | $5.01 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $7.76
| Professional | | $6.46 | $6.46 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $19.50 / $30.20
| Professional | | $5.89 | $19.50 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.94 / $36.31
| Facility | | $5.50 | $7.94 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $5.01 / $7.76
| Professional | | $5.01 | $5.01 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $10.96
| Facility | | $7.94 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $5.75 / $28.84
| Professional | | $5.50 | $5.75 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $5.50 / $6.03
| Professional | | $4.47 | $5.50 | $6.03 |