- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $43.65 / $43.65
| Facility | | $10.96 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $19.95
| Professional | | $10.96 | $14.13 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $24.55 / $28.18
| Professional | | $19.50 | $24.55 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $25.12
| Facility | | $15.85 | $15.85 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $15.85
| Professional | | $11.48 | $11.48 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $53.70
| Professional | | $25.70 | $37.15 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.95 / $28.18
| Professional | | $16.98 | $19.95 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Facility | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $19.05
| Professional | | $10.96 | $14.13 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $39.81 / $54.95
| Professional | | $0.60 | $39.81 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.30
| Facility | | $19.95 | $19.95 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $89.13
| Professional | | $19.95 | $26.30 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $34.67 / $39.81
| Facility | | $12.59 | $34.67 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.80 / $28.18
| Professional | | $10.72 | $13.80 | $28.18 |