- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $229.09
| Facility | | $51.29 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $54.95 / $97.72
| Professional | | $51.29 | $54.95 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $147.91
| Facility | | $83.18 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $57.54 / $91.20
| Professional | | $28.18 | $57.54 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $112.20 / $134.90
| Professional | | $56.23 | $112.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $190.55
| Facility | | $51.29 | $64.57 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $91.20
| Professional | | $51.29 | $61.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $102.33
| Facility | | $51.29 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $64.57
| Professional | | $51.29 | $51.29 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $147.91
| Facility | | $51.29 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $74.13
| Professional | | $51.29 | $57.54 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $199.53
| Facility | | $77.62 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $61.66
| Professional | | $39.81 | $43.65 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $81.28
| Facility | | $61.66 | $77.62 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $61.66
| Professional | | $30.90 | $30.90 | $61.66 |