- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $102.33
| Facility | | $28.18 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.18 / $64.57
| Professional | | $25.70 | $28.18 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $109.65 / $165.96
| Facility | | $38.90 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $102.33
| Professional | | $20.89 | $34.67 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $100.00
| Facility | | $54.95 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $48.98 / $93.33
| Facility | | $22.91 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $37.15 / $91.20
| Professional | | $19.50 | $37.15 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,897.79 / $9,772.37
| Facility | | $56.23 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $58.88
| Professional | | $50.12 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $58.88
| Professional | | $34.67 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $109.65 / $165.96
| Facility | | $38.90 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $102.33
| Professional | | $20.89 | $34.67 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $41.69
| Facility | | $20.89 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $67.61
| Professional | | $20.89 | $34.67 | $67.61 |