- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $53.70
| Professional | | $30.20 | $37.15 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $107.15
| Facility | | $64.57 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $60.26 / $72.44
| Professional | | $54.95 | $60.26 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $199.53 / $316.23
| Facility | | $38.02 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $91.20 / $123.03
| Professional | | $32.36 | $91.20 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $91.20
| Facility | | $35.48 | $54.95 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $138.04 / $169.82
| Professional | | $57.54 | $138.04 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $295.12
| Facility | | $36.31 | $63.10 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $72.44
| Professional | | $26.92 | $31.62 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $70.79
| Professional | | $32.36 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $125.89
| Professional | | $45.71 | $72.44 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $169.82
| Professional | | $64.57 | $95.50 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $128.82 / $302.00
| Facility | | $38.02 | $128.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $316.23
| Professional | | $32.36 | $64.57 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $64.57
| Facility | | $18.62 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $52.48
| Professional | | $20.89 | $31.62 | $52.48 |