- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $123.03
| Facility | | $61.66 | $100.00 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $102.33
| Professional | | $61.66 | $61.66 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $66.07
| Facility | | $50.12 | $64.57 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $72.44 / $74.13
| Professional | | $70.79 | $72.44 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $97.72
| Professional | | $60.26 | $70.79 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $123.03
| Facility | | $63.10 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $302.00
| Professional | | $63.10 | $70.79 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $97.72
| Professional | | $75.86 | $95.50 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $158.49
| Professional | | $79.43 | $97.72 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $60.26 / $125.89
| Facility | | $57.54 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $66.07 / $74.13
| Professional | | $61.66 | $66.07 | $74.13 |