- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $165.96 / $218.78
| Facility | | $77.62 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $89.13
| Professional | | $77.62 | $81.28 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $162.18 / $275.42
| Facility | | $81.28 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $134.90
| Professional | | $81.28 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $125.89 / $190.55
| Professional | | $112.20 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $199.53
| Facility | | $112.20 | $151.36 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $138.04
| Professional | | $67.61 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $89.13 / $109.65
| Facility | | $36.31 | $89.13 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $117.49
| Facility | | $75.86 | $104.71 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $117.49
| Professional | | $75.86 | $104.71 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $173.78
| Facility | | $81.28 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $97.72
| Professional | | $79.43 | $79.43 | $97.72 |