- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $54.95 / $93.33
| Facility | | $18.20 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $18.20 / $22.91
| Professional | | $10.00 | $18.20 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $107.15
| Facility | | $25.12 | $25.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $16.98
| Professional | | $10.00 | $10.00 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $50.12 / $69.18
| Professional | | $29.51 | $50.12 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $112.20
| Facility | | $23.99 | $38.90 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $19.05
| Professional | | $11.48 | $14.79 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $37.15
| Professional | | $25.12 | $30.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $13.80 / $19.50
| Professional | | $8.13 | $13.80 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $19.95 / $30.20
| Facility | | $12.59 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $52.48
| Professional | | $20.42 | $20.42 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $23.44 / $10,000.00
| Facility | | $13.80 | $23.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $23.44 / $10,000.00
| Professional | | $13.80 | $23.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $25.12 / $30.20
| Facility | | $8.71 | $25.12 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $13.80 / $25.12
| Professional | | $8.32 | $13.80 | $25.12 |