- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $123.03
| Facility | | $28.84 | $47.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $52.48
| Professional | | $25.12 | $32.36 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $239.88 / $239.88
| Facility | | $79.43 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $74.13
| Professional | | $21.88 | $27.54 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $75.86 / $165.96
| Facility | | $30.20 | $75.86 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.02 / $75.86
| Professional | | $19.05 | $38.02 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $169.82
| Professional | | $46.77 | $46.77 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $109.65
| Facility | | $21.88 | $38.02 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $125.89 / $141.25
| Professional | | $29.51 | $125.89 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $97.72
| Facility | | $29.51 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $39.81 / $79.43
| Professional | | $18.20 | $39.81 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |