- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $134.90
| Facility | | $37.15 | $45.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $45.71
| Professional | | $19.95 | $26.92 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $107.15
| Facility | | $47.86 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $56.23
| Professional | | $20.42 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $75.86
| Professional | | $60.26 | $66.07 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $45.71
| Facility | | $29.51 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $51.29
| Professional | | $29.51 | $39.81 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $60.26
| Facility | | $29.51 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $60.26
| Professional | | $29.51 | $29.51 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $87.10
| Facility | | $26.92 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $79.43
| Professional | | $29.51 | $35.48 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $89.13 / $123.03
| Facility | | $44.67 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $38.02
| Professional | | $22.39 | $30.20 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $47.86
| Facility | | $18.62 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $41.69
| Professional | | $12.59 | $16.98 | $41.69 |