- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $87.10
| Facility | | $28.18 | $36.31 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $50.12
| Professional | | $28.18 | $28.18 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $147.91
| Facility | | $30.90 | $52.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $51.29
| Professional | | $28.84 | $32.36 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $79.43 / $93.33
| Facility | | $69.18 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $50.12
| Professional | | $31.62 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $46.77
| Professional | | $32.36 | $40.74 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $70.79
| Professional | | $31.62 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $30.90
| Facility | | $28.84 | $28.84 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $38.90
| Professional | | $30.90 | $33.88 | $38.90 |