- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $77.62 / $190.55
| Facility | | $39.81 | $77.62 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $109.65
| Professional | | $38.90 | $51.29 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $323.59
| Facility | | $204.17 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $87.10
| Professional | | $51.29 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $120.23 / $257.04
| Professional | | $51.29 | $120.23 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $85.11 / $263.03
| Facility | | $33.11 | $85.11 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $87.10
| Professional | | $26.30 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $56.23 / $72.44
| Professional | | $51.29 | $56.23 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $95.50
| Facility | | $51.29 | $66.07 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $107.15
| Professional | | $51.29 | $51.29 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $10,000.00
| Facility | | $44.67 | $58.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $60.26 / $10,000.00
| Professional | | $45.71 | $60.26 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $61.66
| Facility | | $30.90 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $51.29
| Professional | | $30.90 | $51.29 | $51.29 |