- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $234.42
| Facility | | $36.31 | $72.44 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $57.54
| Professional | | $19.50 | $36.31 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $77.62
| Facility | | $38.90 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $38.90
| Professional | | $28.84 | $34.67 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $63.10 / $100.00
| Facility | | $17.38 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $39.81 / $54.95
| Professional | | $9.77 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $75.86
| Professional | | $24.55 | $29.51 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $77.62
| Facility | | $38.90 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $77.62
| Professional | | $38.90 | $38.90 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $120.23
| Facility | | $38.90 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $46.77
| Professional | | $34.67 | $34.67 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $102.33
| Facility | | $38.90 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $38.90
| Professional | | $28.84 | $34.67 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $46.77
| Facility | | $34.67 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.22 / $38.90
| Professional | | $8.13 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $19.95 / $69.18
| Professional | | $17.38 | $19.95 | $69.18 |